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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
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):
- 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.
- 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:
- numbing, detachment or lack of emotional response
- reduced awareness of surroundings –- like being in a daze
- having a strong belief that the events are not real
- having a strong sense that the events aren’t happening to the person or that
they don’t affect the person
- forgetting parts of the traumatic event.
- You frequently and involuntarily re-experience the traumatic event by one or
more of the following ways:
- recurrent images
- thoughts
- dreams
- illusions
- flashbacks
- sense of reliving the experience
- distress when an experience reminds one of the event
- You attempt to avoid stimuli that remind you of the event, including:
avoiding thoughts, feelings, conversations, activities, and other people.
- 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.
- These symptoms significantly interferes with your normal life activities in
one or more aspects of your life, i.e. home/family, occupational, etc.
- 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):
- 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.
- You persistently and involuntarily re-experience the traumatic event or some
aspect of it by one or more the following means:
- 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.
- 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.
- 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.
- You feel intense emotional distress when reminded of the event or an aspect
of the event.
- You feel a strong body response when exposed to reminder of the event.
- You continue to avoid experiences that remind you of the traumatic event,
and continue to feel emotional numbness. The symptoms of this may include
- You try to avoid thoughts, feelings and discussion of the traumatic event.
- You try to avoid people, places, and activities that remind you of the
event.
- You’re not able to recall a part of the event.
- You feel separated and estranged from other people.
- You’re not able to experience the full range of emotions, particularly
positive emotions.
- You have difficulty feeling that you have a future or envisioning your
future.
- Your body continues to function at high levels of physiological arousal,
i.e. in the ‘fight or flight’ mode. These symptoms may include:
- impaired sleep
- irritable, prone to outburst of anger
- impaired concentration
- hypervigilence
- exaggerated startle response
- 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
- 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.
- Spend time with your family and get in touch with friends. Encourage your
children and other family members to share their feelings.
- 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.
- Return to your regular routine as soon as you are comfortable doing so.
- 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.
- Keep a journal of your feelings and memories. Writing about your experience
will also help you to process what happened.
- Discuss disturbing feelings that make you uncomfortable with a trusted
friend, relative, or religious person.
- 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.
- If you are recovering from an addiction, this would be a good time to get
extra support and help from your support system.
- Get plenty of rest and exercise. Do some pleasant activities. Don’t be
afraid to laugh.
- Learn some meditation and relaxation exercises which can be practiced on a
daily basis to reduce physical and mental stress.
- Recall how you got through previous difficult events.
- 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.
- If you are grieving consider joining a grief support group. This will be
especially important for young widows and widowers.
- 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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return to professionals write on grief
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