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Psychological Issues

Overview
Mental Health and Children
Additional Resources

Overview

A traumatic event can turn one's world upside down. After surviving a disaster or act of violence, people may feel dazed or even numb. They may also feel sad, helpless, or anxious. In spite of the tragedy, some people just feel happy to be alive.

It is not unusual for them to have bad memories or dreams. They may avoid places or people that remind them of the disaster. They might have trouble sleeping, eating, or paying attention. Many people have short tempers and get angry easily.

These are all normal reactions to stress. It will take time before they start to feel better. They may have strong feelings right away. Or they may not notice a change until much later, after the crisis is over. Stress can change how one act with their friends and family. It will take time for them to feel better and for your life to return to normal. Give them time to heal.

There are five common stages of grief:

Denial
Anger
Bargaining
Sadness
Acceptance and Resolution

Common Traumatic Stress Reactions

(Modified from Disaster Mental Health Response Handbook, p. 28)

Emotional Effects	Cognitive Effects
shock terror irritability blame anger guilt grief or sadness emotional numbing helplessness loss of pleasure derived from familiar activities difficulty feeling happy difficulty experiencing loving feelings	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	Interpersonal Effects
fatigue, exhaustion insomnia cardiovascular strain startle response hyper-arousal increased physical pain reduced immune response headaches gastrointestinal upset decreased appetite decreased libido vulnerability to illness	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

Taken from Effects of Traumatic Stress after Mass Violence, Terror or Disaster (National Center for PTSD, Department of Veterans Affairs)

A traumatic event disrupts life. There is no simple fix to make things better right away. But there are actions that can help victims, their families, and the communities heal. Encourage others to:

Follow a normal routine as much as possible.
Eat healthy meals. Be careful not to skip meals or to overeat.
Exercise and stay active.
Help other people in your community as a volunteer. Stay busy.
Accept help from family, friends, co-workers, or clergy. Talk about feelings with them.
Limit your time around the sights and sounds of what happened. Don't dwell on TV, radio, or newspaper reports on the tragedy.
Sometimes the stress can be too much to handle alone.

Ask for help if someone:

Is not able to take care of themselves or their children.
Is not able to do their job.
Uses alcohol or drugs to get away from their problems.
Feels sad or depressed for more than two weeks
Thinks about suicide.
If you or someone you know is having trouble dealing with the tragedy, ask for help. Talk to a counselor, your doctor, or community organization, such as the National Suicide Prevention Lifeline (1-800-273-TALK).

See below for more information:

Breslau, Naomi. (1990). Stressors: Continuous and discontinuous. Journal of Applied Social Psychology, 20(20), 1666-1673.
Bryant, R.A. (2000). Acute Stress Disorder. PTSD Research Quarterly, 11(2), 1-7.
Bryant, R.A. & Harvey, A.G. (1997). Acute Stress Disorder: A critical review of diagnostic issues. Clinical Psychology Review, 17, 757-773.
Kessler, R.C., Sonnega, A., Bromet, E.J., Hughes, M., & Nelson, C.B. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
Koopman, C., Classen, C.C., Cardena, E., & Spiegel, D. (1995). When disaster strikes, Acute Stress Disorder may follow. Journal of Traumatic Stress, 8(1), 29-46.
Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., et al. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
NSW Institute of Psychiatry and Centre for Mental Health. (2000). Disaster Mental Health Response Handbook. North Sydney: NSW Health.
Ursano, R.J., Grieger, T.A., & McCarroll, J.E. (1996). Prevention of posttraumatic stress: Consultation, training, and early treatment. In B. A. Van der Kolk, A.C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 441-462). New York: Guilford Press.

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Mental Health and Children

Children may need more help adjusting to a traumatic event such as a terrorist attack. A child's reaction to trauma will likely vary depending on his or her age. Below lists some of the manifestations of psychological trauma varying by age group:

Birth - Age 2
- Response usually determined by caregiver's coping skills
- May become fussy or have sleeping trouble
Age 2-6
- Commonly think that the event was their fault
- Have a hard time realizing death as permanent
- May have increased temper tantrums, trouble sleeping, or cling to caregivers
Age 7-12
- Have difficulty fully understanding
- May manifest physical symptoms due to stress
- Have an increase in school related issues
- Lose interest in activities
Age 13-18
- More likely to keep feelings inside or become withdrawn
- Increased activity
- Changes in appetite and sleeping patterns
- Behavioral changes

There are steps that can be taken to help ease or reduce the amount of psychological stress to a child. In a disaster or terrorist event, the need for mental health services will be far greater and the resources even less adequate. Schools and pediatricians have become the default mental health providers for children.

Children may develop psychiatric symptoms and disorders - including posttraumatic stress disorder (PTSD), acute stress disorder (ASD), anxiety, depression, and behavioral problems - after exposure to disasters or terrorist incidents. Grief in these situations can be compounded by the traumatic circumstances associated with the loss.

See below for more information:

Anatomic, Physiologic, Immunologic, Developmental, Psychologic Differences of Children. Chapter 8: Mental Health Issues. (HHS/AHRQ)
Joshi, P.T., Lewin, S.M., O'Donnell, D.A. 2005. The Handbook on Frequently Asked Questions Following Traumatic Events: Violence, Disasters, or Terrorism. (PDF - 4.02 MB) (Children's National Medical Center. The International Center to Heal Our Children: Building Healthy Minds and Futures, Children's National Medical Center, Washington, D.C.)

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