How much stress is expected following a traumatic event?
The more extensive the impact of an event has on our lives, the greater the response at the time and in the future, especially in terms of both threat to basic needs and intensity of experience. Even for those who were not an eyewitness or were not at the scenes, psychological trauma may be felt. What are the normal reactions to “highly stressful” events? The general and normal “responses” to trauma are:
- Alarm – This describes what most felt during the media presentation: it is characterized by disbelief, efforts to make sense, shock and stunned confusion. Our usual abilities to cope are overwhelmed. There are heightened levels of suggestibility, fear and inadequacy. Secondary responses that interfere with thinking, emotions, performance and physical integrity may continue.
- Resistance – This involves coming to terms with the event and experiencing less intrusive responses and more personal control. Then coping is effective, normalcy begins to return although the memory may persist.
- Exhaustion – This occurs when coping or management of the experience is ineffective. Medical and therapeutic interventions are required to manage a person who becomes traumatically exhausted.
Mild to moderate stress reactions in the emergency and early post-impact phases of disaster are highly prevalent because survivors (and their families, community members and rescue workers) accurately recognize the grave danger in disaster. Although stress reactions may seem 'extreme', and cause distress, they generally do not become chronic problems. Most people recover fully from even moderate stress reactions within 6 to 16 months.
In fact, resilience is probably the most common observation after all disasters. In addition, the effects of traumatic events are not always bad. Disaster may bring a community closer together or reorient an individual to new priorities, goals or values. This concept has been referred to as 'post traumatic growth' by some authors.
There are a number of possible reactions to a traumatic situation which are considered within the "norm" for individuals experiencing traumatic stress.
- Traumatic Stress Reactions Emotional Effects: shock, terror, irritability, blame, anger, guilt, grief or sadness, emotional numbing, helplessness, loss of pleasure derived from familiar activities, difficulty feeling happy, difficulty feeling loving
- Cognitive Effects: impaired concentration, impaired decision-making ability, memory impairment, disbelief, confusion, nightmares, decreased self-esteem, decreased self-efficacy, self-blame, intrusive thoughts/memories, worry, dissociation (e.g., tunnel vision, dreamlike or "spacey" feeling)
- Physical Effects: fatigue, exhaustion, insomnia, cardiovascular strain, startle response, hyperarousal, increased physical pain, reduced immune response, headaches, gastrointestinal upset, decreased appetite, decreased libido, vulnerability to illness
- Interpersonal Effects: increased relational conflict, social withdrawal, reduced relational intimacy, alienation, impaired work performance, impaired school performance, decreased satisfaction, distrust, externalization of blame, externalization of vulnerability, feeling abandoned/rejected, overprotectiveness
Although many of these reactions seem negative, it must be emphasized that people also show a number of positive responses in the aftermath of disaster. These include:
- Resilience and coping,
- Altruism (eg. helping save or comfort others),
- Relief and elation at surviving disastersense of excitement and greater self-worth, and
- Changes in the way they view the future, and feelings of 'learning about one’s strengths' and 'growing' from the experience.
Problematic Stress Responses
The following responses are less common, and indicated the likelihood of the individual's need for assistance from a medical or mental health professional:
- Severe dissociation (feeling as if you or the world is "unreal," not feeling connected to one's own body, losing one's sense of identity or taking on a new identity, amnesia)
- Severe intrusive re-experiencing (flashbacks, terrifying screen memories or nightmares repetitive automatic re-enactment)
- Extreme avoidance (agoraphobic-like social or vocational withdrawal, compulsive avoidance)
- Severe hyperarousal (panic episodes, terrifying nightmares, difficulty controlling violent impulses, inability to concentrate)
- Debilitating anxiety (ruminative worry, severe phobias, unshakable obsessions, paralyzing nervousness, fear of losing control/going crazy)
- Severe depression (lack of pleasure in life, worthlessness, self-blame, dependency, early awakenings)
- Problematic substance use (abuse or dependency, self-medication)
- Psychotic symptoms (delusions, hallucinations, bizarre thoughts or images)