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Traumatic Stress Reactions - What They Are and What to Do About Them
by Laura Slap-Shelton, Psy.D.
10-1-2001

I.   Traumatic Stress - An Introduction
II.  Acute Stress Disorder
III.  Posttraumatic Stress Disorder
IV.  Steps to Take Following a Traumatic Event
V.  Treatments for Traumatic Stress

I. Traumatic Stress- An Introduction

Many people have been discussing traumatic stress reaction to describe the emotional experiences of people who were strongly effected by the events of September 11. While stress reactions can feel and appear to be very strange they are, in fact, normal reactions to abnormal events. When an event is overly aversive, powerful, and frightening, the brain and body react in certain now well charted ways to process the stress and the memories of the stress. The degree of control one has over the stressful situation will also effect the level of trauma -- generally, the less control, the greater the trauma.

Traumatic memories are processed differently than nontraumatic memories. This different processing leads to the symptoms associated with traumatic stress. While the brain’s memory system processes normal every day events and mildly stressful events in such a way that they eventually reside quietly in ‘storage’ with little emotional charge, traumatic memories are processed by a different brain system. Traumatic memories tend to live on as fully dimensional and colorful ‘films’ of events, which intrude into daily life at unwanted and unexpected times. Even if the memory does not fully flash before one’s eyes, the emotion associated with the memory may be present when it is not appropriate to what is happening in a person’s life.

Events of the magnitude of the attacks on the World Trade Center and the Pentagon are likely to cause some form of traumatic stress in many people, even people who have only watched the events on television. In addition, if a person already has had previous traumatic events, the attacks on the U.S. are likely to bring up those traumatic events, possibly in new and unexpected ways. Thus people who may have worked hard to overcome a difficulty in their lives may be at risk for relapsing into previous less effective ways of handling their fears and anxieties.

Psychiatrists and psychologists have divided traumatic stress reactions into two categories: Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD). ASD includes symptoms which develop within 4 weeks of the traumatic event and which last up to 4 weeks, but then begin to dissipate. If the symptoms persist longer than 4 weeks, possibly worsening, the trauma is classified as PTSD. Interestingly, PTSD may also develop long after the traumatic event is over. Recent studies have noted that some WWII veterans began to develop symptoms of PTSD in their older years. Some hypothesized that as the robustness of their brains decreased with age they were more susceptible to developing symptoms of PTSD. Sometimes an event can trigger the recall of previously suppressed memories, which then initiates the development of PTSD symptoms.

Studies have found that knowing the symptoms of traumatic stress disorders and what to expect, can help to avoid further loss of control, and can help to reduce the severity of a person’s traumatic stress syndrome. The symptoms of ASD and PTSD are summarized below.

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II. Symptoms of Acute Stress Disorder (ASD)

The Diagnostic Standard Manual of Mental Disorders -- 4th Edition (DSM-IV) was developed to establish uniform ways of diagnosing psychiatric problems. It is recommended that if you find that you have some or all of the symptoms listed here and they are impairing your ability to function that you see a psychologist or psychiatrist or other licensed mental health professional trained in helping individuals with traumatic stress reactions. The DSM-IV’s criteria for ASD are summarized as follows (Diagnostic Standard Manual of Mental Disorders -- Fourth Edition, American Psychiatric Association, Washington D.C., 1994, pp.429-432):

  1. You were involved in an event in which you directly or indirectly experienced threatened death, or serious injury or a threat to the physical integrity of self or others and your response involved intense fear, helplessness or horror.

  2. In the course of the event you noticed that in some way your perception of events or your emotions in relation to the event felt altered or diminished so that you were not fully experiencing the event. This is sometimes called dissociation. The possible symptoms of dissociation include:
    1. numbing, detachment or lack of emotional response
    2. reduced awareness of surroundings –- like being in a daze
    3. having a strong belief that the events are not real
    4. having a strong sense that the events aren’t happening to the person or that they don’t affect the person
    5. forgetting parts of the traumatic event.

  3. You frequently and involuntarily re-experience the traumatic event by one or more of the following ways:
    1. recurrent images
    2. thoughts
    3. dreams
    4. illusions
    5. flashbacks
    6. sense of reliving the experience
    7. distress when an experience reminds one of the event

  4. You attempt to avoid stimuli that remind you of the event, including: avoiding thoughts, feelings, conversations, activities, and other people.

  5. You experience significant symptoms of anxiety or increased arousal, including: poor sleep, insomnia, poor concentration, hypervigilence, exaggerated startle response, trouble being still for very long.

  6. These symptoms significantly interferes with your normal life activities in one or more aspects of your life, i.e. home/family, occupational, etc.

  7. These symptoms last at least 2 days, and as long as 4 weeks, and begin within 4 weeks of the traumatic event.

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III. Symptoms of Posttraumatic Stress Syndrome (PTSD)

The Diagnostic Standard Manual -- 4th Edition (DSM-IV) was developed to establish uniform ways of diagnosing psychiatric problems. PTSD is considered acute if the symptoms persist less than 3 months. It is considered chronic when they persist beyond 3 months. It is considered delayed if the symptoms become present 6 months or more after the traumatic event. It is recommended that if you find that you have some or all of the symptoms listed here and they are impairing your ability to function that you see a psychologist or psychiatrist or other licensed mental health professional trained in helping individuals with traumatic stress reactions. The DSM-IV’s criteria for PTSD are summarized as follows (Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition, American Psychiatric Association, Washington D.C. 1994, pp. 424-429):

  1. You have been directly or indirectly exposed to a traumatic event which involved actual or threatened death or serious injury, or a threat to physical integrity of self or others and your response involved intense fear, helplessness, or horror. In children this may be seen in disorganized and/or agitated behavior.

  2. You persistently and involuntarily re-experience the traumatic event or some aspect of it by one or more the following means:
    1. You have recurrent and intrusive recollections of the event. In your children you may see repetitive play which re-enacts the event or an aspect of the event.
    2. You have recurrent upsetting dreams about the event. In your children you may see repeating upsetting dreams which on the surface do not appear directly linked to the event.
    3. You act or feel as if the traumatic event were re-occurring. This could be in the form of flashbacks, illusions, hallucinations, and acting or feeling as if the event was happening. In your children you may see the child acting out parts of the event.
    4. You feel intense emotional distress when reminded of the event or an aspect of the event.
    5. You feel a strong body response when exposed to reminder of the event.

  3. You continue to avoid experiences that remind you of the traumatic event, and continue to feel emotional numbness. The symptoms of this may include
    1. You try to avoid thoughts, feelings and discussion of the traumatic event.
    2. You try to avoid people, places, and activities that remind you of the event.
    3. You’re not able to recall a part of the event.
    4. You feel separated and estranged from other people.
    5. You’re not able to experience the full range of emotions, particularly positive emotions.
    6. You have difficulty feeling that you have a future or envisioning your future.

  4. Your body continues to function at high levels of physiological arousal, i.e. in the ‘fight or flight’ mode. These symptoms may include:
    1. impaired sleep
    2. irritable, prone to outburst of anger
    3. impaired concentration
    4. hypervigilence
    5. exaggerated startle response

  5. Your symptoms have lasted longer than 4 week and significantly disrupt your normal life activities.

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IV. Steps to Take Following a Traumatic Event

  1. The most important thing to do following a traumatic event is to talk about it with friends and loved ones. Talking allows you to share your feelings and to know that others are having similar experiences. It helps you to connect with and process different aspects of the trauma.

  2. Spend time with your family and get in touch with friends. Encourage your children and other family members to share their feelings.

  3. Take action by doing something positive to help others. Volunteering and donating are positive ways to help others and take some control over the traumatic event.

  4. Return to your regular routine as soon as you are comfortable doing so.

  5. If there is no support for traumatized victims of the 9-11 disaster at work, you may want to initiate having your company bring in professional support for company employees for the next several months.

  6. Keep a journal of your feelings and memories. Writing about your experience will also help you to process what happened.

  7. Discuss disturbing feelings that make you uncomfortable with a trusted friend, relative, or religious person.

  8. Seek professional help if you are feeling unable to function. If you have been treated for a previous traumatic event this would be a good time to re-connect with your therapist.

  9. If you are recovering from an addiction, this would be a good time to get extra support and help from your support system.

  10. Get plenty of rest and exercise. Do some pleasant activities. Don’t be afraid to laugh.

  11. Learn some meditation and relaxation exercises which can be practiced on a daily basis to reduce physical and mental stress.

  12. Recall how you got through previous difficult events.

  13. If you are grieving a personal loss, take time to connect with your feelings of grief, and to value the meaning of the person’s life, now lost. Participate in the rituals of grieving that are part of your faith, or create your own rituals.

  14. If you are grieving consider joining a grief support group. This will be especially important for young widows and widowers.

  15. Learn more about traumatic stress by reading about it and ways to cope with it.

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V. Treatments for Traumatic Stress

Treatment for traumatic stress can be provided through both psychotherapy including types of therapy designed specifically to work with individuals who have experienced traumas, and with medications which can help decrease significant mood disturbances and help with sleep and other secondary physiological reactions to extreme stress.

It is important to seek help from licensed professionals who have training in helping individuals who have been traumatized.

Each person will experience their traumatic stress in their own unique way despite the shared common elements of the syndrome. It will be important to work with a therapist you trust, and who is able to help you work through your own personal connections and reactions to the trauma you have experienced.

Sources of professionals trained to work with individuals with traumatic grief can be found in your community and through professional organizations.

 

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