Mass Disasters, Trauma, and Loss

Disasters commonly occur. They may becaused by nature, including earthquakes,floods, wildfires, hurricanes, or tornadoes.In addition, disasters may be human-made,caused by people through mishap orneglect, such as a work accident or anapartment fire, or by deliberate intention,as with terrorism. Often large numbers ofpeople are affected and they share theirexperience of trauma and traumatic loss.Many losses may occur after a disaster,including loss of loved ones, coworkers,neighbors, and pets, and loss of homes,workplaces, schools, houses of worship,possessions, and communities. Survivorsmay also lose their routine way of livingand working, going to school, and beingwith others. Some may lose their confidencein the future.

Some disasters, such as terrorism, continueover a long period of time and may createan on-going insecurity and exposure todanger or threat of danger which may makeit more difficult for some people to functionin their lives. After a disaster, it is normal toexperience a number of stress reactions thatmay continue for a significant period. Andafter the sudden, traumatic loss caused bydisasters, it is normal for grieving andmourning to be uneven, more intensely felt,and extended over time. In all disasters, theexperience of safety, security, andpredictability in the world is challenged,and a sense of uncertainty becomes a partof life.

What can I expect afterexperiencing a disaster?

Most child, adolescent, adult, and olderadult survivors experience some of thefollowing normal stress responses to varyingdegrees. They may last for many monthsafter the disaster has ended, and evenlonger. Normal stress reactions include:

• Emotional (feeling) reactions: feelings ofshock, disbelief, anxiety, fear, grief, anger,resentment, guilt, shame, helplessness,hopelessness, betrayal, depression,emotional numbness (difficulty havingfeelings, including those of love andintimacy, or taking interest and pleasurein day-to-day activities)

• Cognitive (thinking) reactions: confusion,disorientation, indecisiveness, worry,shortened attention span, difficultyconcentrating, memory loss, unwantedmemories, repeated imagery, self-blame

• Physical (bodily) reactions: tension,fatigue, edginess, difficulty sleeping,nightmares, being startled easily, racingheartbeat, nausea, aches and pains,worsening health conditions, change inappetite, change in sex drive

• Interpersonal reactions: neediness,dependency, distrust, irritability, conflict,withdrawal, isolation, feeling rejected orabandoned, being distant, judgmental, orover-controlling in friendships, marriages,family, or other relationships.

• Spiritual ( meaning) reactions:wondering why, why me where was God;feeling as if life is not worth living.

What factors increase the risk oflasting vulnerability?

During or after massive disasters, manysurvivors may be directly exposed to orwitness things that may make themparticularly vulnerable to serious stressreactions. Disaster stress may revivememories or experiences of earlier trauma,as well as possibly intensifying pre-existingsocial, economic, spiritual, psychological, ormedical problems. While trauma reactionscan become lasting problems, the sharedexperience of disasters and people’sresiliency can provide support. Being awareof risk factors is important. They include:

• Loss of family, neighborhood, orcommunity

• Life-threatening danger or physical harm(especially to children)

• Exposure to horrible death, bodily injury,or bodies

• Extreme environmental or humanviolence or destruction

• Loss of home or valued possessions

• Loss of communication with or supportfrom important people in one's life

• Intense emotional demands

• Extreme fatigue, weather exposure,hunger, or sleep deprivation

• Extended exposure to danger, loss,emotional/physical strain

• Exposure to toxic contamination (such asgas, fumes, chemicals, radioactivity, orbiological agents)

Studies show that some individuals aremore vulnerable to serious stress reactionsand lasting difficulty, including those witha history of:

• Other traumatic experiences (such assevere accidents, abuse, assault, combat,immigrant and refugee experiences,rescue work)

• Chronic medical illness or psychologicalproblems

• Chronic poverty, homelessness,unemployment, or discrimination

• Recent or earlier major life stressors oremotional strain (such as divorce or jobloss.

What can survivors do to reducevulnerability to serious emotionalreactions and to achieve the bestrecovery from disaster stress?

Observations by mental health specialistswho assist survivors in the wake of disastersuggest that the following steps help toreduce stress symptoms and to promotepost-disaster readjustment:

• Protect: find a safe haven that providesshelter, food and water, sanitation,privacy, and opportunities to sit quietly,relax, and sleep, at least briefly

• Direct: begin working on immediatepersonal and family priorities to help youand your loved ones preserve or regain asense of hope, purpose, and self-esteem

• Connect: maintain or re-establishcommunication with family, peers andcounselors in order to talk about theexperiences. Survivors may want to findopportunities to "tell their stories" toothers who express interest and concernand, when they are able, to listen toothers as they tell theirs, in order torelease the stress a little bit at a time andtry to create meaning

• Select: identify key resources such asFederal Emergency Management Agency(FEMA), the Red Cross, the SalvationArmy, local and state health departmentsfor clean-up, health, housing, and basicemergency assistance. Identify localcultural or community supports to helpmaintain or reestablish normal activitiessuch as attending religious services.

Taking every day one at a time is essentialin disaster's wake. Each day is a newopportunity to take steps toward recovery.People affected by disasters should try to:

• Focus on what's most important tothemselves and their families today;

• Try to learn and understand what theyand their loved ones are experiencing, tohelp remember what's important

• Understand personally what theseexperiences mean as a part of their lives,so that they will feel able to go on withtheir lives and even grow personally

• Take good care of themselves physically,including exercising regularly, eatingwell, and getting enough sleep, to reducestress and prevent physical illness

• Work together with others in theircommunities to improve conditions,reach out to persons who aremarginalized or isolated, and otherwisepromote recovery.

How would I decide I needprofessional help?

Most disaster survivors experience manynormal responses and for some, theirpersonal resources and capacities may growand their relationships may strengthen.However, many disaster survivorsexperience reactions during and afterdisasters that concern them, often when thedisaster was caused by human action orincluded horror or loss of life. Someproblematic responses are as follows:

• Intrusive re-experiencing (terrifyingmemories, nightmares, or flashbacks)

• Unsafe attempts to avoid disturbingmemories (such as through substance useor alcohol)

• Complete emotional numbing (unable tofeel emotion, as if empty)

• Extended hyperarousal (panic attacks,rage, extreme irritability, intenseagitation, exaggerated startle response)

• Severe anxiety (paralyzing worry,extreme helplessness)

• Severe depression (loss of energy,interest, self-worth, or motivation)

• Loss of meaning and hope

• Sustained anger or rage

• Dissociation (feeling unreal or outsideoneself, as in a dream; having "blank"periods of time one cannot remember)

If after the end of a disaster, these normalexperiences do not slowly improve or ifthey worsen with time, it is helpful to findprofessional support. People who wish toconsider therapy should select a trainedmental health professional who is knowledge-able about trauma and natural disasters.

This pamphlet is adapted from a fact sheetdesigned by the National Center for PTSDand edited by the Public EducationCommittee of the International Society forTraumatic Stress Studies.

Where to Go for Help

People who wish to consider therapy shouldselect a trained mental health professionalwho is knowledgeable about trauma andnatural disasters. A family doctor, clergyperson, local mental health association, statepsychiatric, psychological, or social workassociation, or health insurer may be helpfulin providing a referral to a counselor ortherapist with experience in treating peopleaffected by traumatic stress. For moreinformation about traumatic stress or theInternational Society of Traumatic StressStudies, call 1-800-469-PTSD (7873).

60 Revere Drive, Suite 500, Northbrook, IL 60062 USA

Tel: 847/480-9028 Fax: 847/480-9282

Toll free: 877/469-7873

www.istss.org

What is ISTSS?

The International Society for Traumatic Stress

Studies is a nonprofit organization whose goal is to

ensure that everyone affected by trauma receives the

best possible professional response, and to reduce

traumatic stressors and their immediate and long-

term consequences worldwide.

ISTSS provides an independent community for sup-

porting and sharing research, clinical strategies,

public policy concerns and theoretical formulations

on trauma. ISTSS members include psychiatrists,

psychologists, social workers, nurses, counselors,

researchers, journalists, clergy, law enforcement, cor-

rectional facilities administrators, advocates and

others with an interest in the treatment and study of

traumatic stress.

Members work in clinical and nonclinical settings

around the world, including public and private

health facilities, private practice, universities and

research foundations.

This pamphlet is adapted from a fact sheet

designed by the National Center for PTSD and

edited by the Public Education Committee of the

International Society for Traumatic Stress Studies.

Revised November, 2001

© 2000

Photo Credit: Anastasia Athans-Stothoff