The debris are all too visible from the tornadoes that visited catastrophe on Oklahoma this past week. Lives were lost, property irrevocably destroyed and neighborhoods razed. The tornado might as well have been a load of thousand-pound bombs from above, looking at the destruction it rained. The damage, however, will not stop there.
This natural yet preternaturally awesome storm now leaves in its wake another form of disruption -- insidious and internal to those who witnessed or were impacted by its force. This is the stress response that is first acute, lasting for days or weeks, and for some post-traumatic when symptoms will not abate or return as a repeat psychic storm after laying dormant for months or longer. We know these as acute and post-traumatic stress disorders.
After rescue efforts are exhausted and the recovery phase of a disaster begins, what might traumatic disorders look like in you or a loved one in the aftermath of the destruction?
What Might Acute Stress Disorder Look Like to You?
After the tornado, a person is deeply shaken and may not be able to stop thinking about the event. He or she may have difficulty sleeping and may be "jumpy" or irritable. Taking care of everyday business is hard and spending time with others feels like a burden. The disaster survivor person may smoke or drink more and withdraw from others.
Sometimes a person will experience dissociation (where someone feels and appears very distant or shut off from what is going on), or re-experience the event, and feel intense anxiety and want to avoid going out and participating in everyday life; these symptoms can impair functioning at school or work and within the family. For the diagnosis of an acute stress disorder (ASD) to be made, the condition must come on within four weeks of the trauma and last more than a couple of days. If significant symptoms persist for longer than a month, it's likely that the ASD has progressed to PTSD
What Might PTSD Look Like to You?
The life-threatening or horrific event happened in recent months or may have happened in the past -- even years ago. But with some trigger, another storm or personal challenge, a person begins to change: They turn inward, become isolated and preoccupied, and have difficulty concentrating and completing tasks. Someone you know well seems different, not in a small way, leaving you confused and concerned. Some people will startle very easily, at something as minor as the sound of a door closing or a telephone ringing. Some will be highly vigilant, as if another storm was on the horizon. If a survivor can talk about what he or she is feeling they might describe feeling scared, numb, or both. Images of the disaster or its aftermath can erupt into a person's mind, sometimes without a clear trigger. Sleep can be terribly restless and full of anxious dreams. Alcohol and drug abuse is very common, and if a person smokes cigarettes he or she will smoke a lot more. Suicidal thoughts may occur -- paradoxically -- in a person who has lived through a life-threatening event.
PTSD symptoms must persist for over a month for the diagnosis to be made. Unlike ASD, PTSD may appear after a month or, as mentioned, sit dormant, only to arise months or years later, typically after some destabilizing event or illness. PTSD that arises well after the event is referred to as delayed-onset PTSD. Along with alcohol or drug abuse, the presence of other mental disorders (like depression or bipolar disorder) is a powerful risk factor for the development of PTSD after a traumatic experience. These factors also forecast that treatment will be more challenging.
The risk of developing ASD and PTSD can be mitigated by protective factors (such as supportive families and communities as well as faith) and resilience. Most people are resilient and with time will rebuild their lives, physically as well as emotionally. But for those who will not -- those at risk to develop a mental disorder after a tornado, or any natural or human-made disaster -- the principles of early identification and early mental health intervention will be as necessary a salve as the restoration of their property and community.
Additional information:
Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D. W., King, L. A., et al. (2007). "Exposure to hurricane-related stressors and mental illness after Hurricane Katrina." Archives of General Psychiatry, 64, 1427-1434.
Galea, S., Nandi, A., & Vlahov, D. (2005). "The epidemiology of post-traumatic stress disorder after disasters." Epidemiologic Reviews, 27, 78-91.
Norris FH, Tracy M, Galea S. "Looking for resilience: Understanding the longitudinal trajectories of responses to stress." Social Science and Medicine. 2009;68(12):2190-2198. PMID: 19403217. URL: http://dx.doi.org/10.1016/j.socscimed.2009.03.043
Dr. Sederer's book for families who have a member with a mental illness, The Family Guide to Mental Health Care (2013), is now available from your preferred book merchant.
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The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company
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