ISTSS : Terrorism and Trauma : Mass Disasters, Trauma, and Loss

Mass Disasters, Trauma, and Loss

Disasters occur commonly, and affect individuals as well as their communities. They may be human-made, caused by deliberate intention, as with terrorism, civil unrest, and war experiences, or caused by people through mishap or neglect, such as a work accident or an apartment fire. In addition disasters may be caused by nature, including earthquakes, floods, wildfires, hurricanes, or tornadoes.

Often large numbers of people are affected and they share their experience 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. Survivors may also lose their routine way of living and working, going to school, and being with others. Some may lose their confidence in the future.

Some disasters, such as terrorism, continue over a long period. These may create an on-going insecurity and exposure to danger or threat of danger, which may make it more difficult for some people to function in their lives.

After a disaster, it is normal to experience a number of stress reactions that may continue for a significant period. And after the sudden, traumatic loss caused by disasters, it is normal for grieving and mourning to be uneven, more intensely felt, and extended over time. In all disasters, the experience of safety, security, and predictability in the world is challenged, and a sense of uncertainty becomes a part of life.

What can I expect after experiencing a disaster?
Most child, adolescent, adult, and older adult survivors experience some of the following normal stress responses to varying degrees. They may last for many months after the disaster has ended, and even longer. Normal stress reactions include:

Emotional (feeling) reactions: feelings of shock, disbelief, anxiety, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, betrayal, depression, emotional numbness (difficulty having feelings, including those of love and intimacy, or taking interest and pleasure in day-to-day activities)
Cognitive (thinking) reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, repeated imagery, self-blame
Physical (bodily) reactions: tension, fatigue, edginess, difficulty sleeping, nightmares, being startled easily, racing heartbeat, nausea, aches and pains, worsening health conditions, change in appetite, change in sex drive
Interpersonal reactions: neediness; dependency; distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-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, loss of hope.

What factors increase the risk of lasting vulnerability?
During or after massive disasters, many survivors may be directly exposed to or witness things that may make them particularly vulnerable to serious stress reactions.

Disaster stress may revive memories or experiences of earlier trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems. While trauma reactions can become lasting problems, the shared experience of disasters and people's resiliency can provide support. Being aware of risk factors is important. They include:

Loss of family, neighborhood, or community
Life-threatening danger or physical harm (especially to children)
Exposure to horrible death, bodily injury, or bodies
Extreme environmental or human violence or destruction
Loss of home or valued possessions
Loss of communication with or support from 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 as gas, fumes, chemicals, radioactivity, or biological agents)

Studies show that some individuals are more vulnerable to serious stress reactions and lasting difficulty, including those whose histories include:

Other traumatic experiences (such as severe accidents, abuse, assault, combat, immigrant and refugee experiences, rescue work)
Chronic medical illness or psychological problems
Chronic poverty, homelessness, unemployment, or discrimination
Recent or earlier major life stressors or emotional strain (such as divorce or job loss).

What can survivors do to reduce vulnerability to serious emotional reactions and to achieve the best recovery from disaster stress? Observations by mental health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote post-disaster readjustment:

Protect: find a safe haven that provides shelter, food and water, sanitation, privacy, and opportunities to sit quietly, relax, and sleep, at least briefly
Direct: begin working on immediate personal and family priorities to help you and your loved ones preserve or regain a sense of hope, purpose, and self-esteem
Connect: maintain or re-establish communication with family, peers, and counselors in order to talk about the experiences. Survivors may want to find opportunities to "tell their stories" to others who express interest and concern and, when they are able, to listen to others as they tell theirs, in order to release the stress a little bit at a time and try to create meaning
Select: identify key resources such as Federal Emergency Management Agency (FEMA), the Red Cross, the Salvation Army, local and state health departments for clean-up, health, housing, and basic emergency assistance. Identify local cultural or community supports to help maintain or reestablish normal activities such as attending religious services.

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

Focus on what's most important to themselves and their families today;
Try to learn and understand what they and their loved ones are experiencing, to help remember what's important
Understand personally what these experiences mean as a part of their lives, so that they will feel able to go on with their lives and even grow personally
Take good care of themselves physically, including exercising regularly, eating well, and getting enough sleep, to reduce stress and prevent physical illness
Work together with others in their communities to improve conditions, reach out to persons who are marginalized or isolated, and otherwise promote recovery.

How would I decide I need professional help?
Most disaster survivors experience many normal responses and for some, their personal resources and capacities may grow and their relationships may strengthen. However, many survivors experience reactions during and after disasters that concern them, often when the disaster was caused by human action or included horror or loss of life. Some problematic responses are as follows:

Intrusive re-experiencing (terrifying memories, nightmares, or flashbacks)
Unsafe attempts to avoid disturbing memories (such as through substance use or alcohol)
On-going emotional numbing (unable to feel emotion, as if empty)
Extended hyperarousal (panic attacks, rage, extreme irritability, intense agitation, 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 outside oneself, as in a dream; having "blank" periods of time one cannot remember)

If after the end of a disaster, these normal experiences do not slowly improve, if they worsen with time, or if they cause difficulties in relationships or work, it is helpful to find professional support. People who wish to consider therapy should select a trained mental health professional who is knowledgeable about trauma as well as natural- and human-caused disasters. A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist.

For more information about traumatic stress or the International Society for Traumatic Stress Studies, call 1-877-507-PTSD (7873).

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