Normal Reactions to an Abnormal Situation

There are a number of possible reactions to a traumatic situation which are considered within the “norm” for individuals experiencing traumatic stress:

Traumatic Stress Reactions

Emotional Effects
Symptoms: shock, terror, irritability, blame, anger, guilt, grief, sadness, emotional numbing, helplessness, loss of pleasure derived from familiar activities, difficulty feeling happy, difficulty experiencing loving feelings

Physical
Symptoms: fatigue, exhaustion, insomnia, cardiovascular strain, startle response, hyperarousal, increased physical pain, reduced immune response, headaches, gastrointestinal upset, decreased appetite, decreased libido, vulnerability to illness

Cognitive Effects
Symptoms: 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)

Interpersonal Effects
Symptoms: 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

Although many of the above reactions seem negative, it must be emphasized that people also show a number of positive responses in the aftermath of disaster. These include resilience and coping; altruism (eg. helping save or comfort others); relief and elation at surviving disaster; sense of excitement and greater self-worth; changes in the way they view the future; and feelings of identifying one’s strengths and “growing” from the experience.

Problematic Stress Responses

The following responses are less common, and indicate the likelihood of the individual’s need for assistance from a medical or mental health professional:

  • Severe dissociation (feeling as if you or the world is “unreal,” not feeling connected to one’s own body, losing one’s sense of identity or taking on a new identity, amnesia)
  • Severe intrusive re-experiencing (flashbacks, terrifying screen memories or nightmares, repetitive automatic re-enactment)
  • Extreme avoidance (agoraphobic-like social or vocational withdrawal, compulsive avoidance)
  • Severe hyperarousal (panic episodes, terrifying nightmares, difficulty controlling violent impulses, inability to concentrate)
  • Debilitating anxiety (ruminative worry, severe phobias, unshakeable obsessions, paralyzing nervousness, fear of losing control/going crazy)
  • Severe Depression (lack of pleasure in life, worthlessness, self-blame, dependency, early wakenings)
  • Problematic substance use (abuse or dependency, self-medication)
  • Psychotic symptoms (delusions, hallucinations, bizarre thoughts or images)

Some people will be more affected by a traumatic event for a longer period of time than others, depending on the nature of the event and the nature of the individual who experienced the event.

One of the most debilitating effects of traumatic stress is a condition known as posttraumatic stress disorder (PTSD). The current trauma literature suggests that many factors are related to increased or decreased risk for PTSD. The likelihood of developing PTSD and the severity and chronicity of symptoms experienced, is a function of many variables, the most important being exposure to a traumatic event. It is therefore important to bear in mind that, even among vulnerable individuals, PTSD would not exist without exposure to a traumatic event.

Symptoms of PTSD

Post traumatic stress disorder (PTSD) is a mental disorder resulting from exposure to an extreme traumatic stressor. PTSD has a number of unique defining features and diagnostic criteria, as published in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV, 1994). These Criteria include:

  • Exposure to a traumatic stressor
  • Re-experiencing symptoms
  • Avoidance and numbing symptoms
  • Symptoms of increased arousal
  • Duration of at least one month
  • Significant distress or impairment of functioning

Exposure to a traumatic stressor

To be diagnosed with PTSD, the person must have been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and (2) the person’s response to the trauma involved intense fear, helplessness, or horror. (In children, this may be expressed instead by disorganized or agitated behavior.)

Stressful events of daily life that do not meet these criteria include divorce and financial crises, which may lead to adjustment problems, but are not sufficient to meet criterion A for PTSD.

Qualifying stressors must induce an intense emotional response. According to DSM-IV, a qualifying stressor must not only be threatening, but it must also induce a response involving intense fear, helplessness, or horror. Some severely traumatized individuals may dissociate during a stressor or have a blunted response, due to defensive avoidance and numbing. Often, the intense emotional response to the stressor may not occur until considerable time has elapsed after the incident has terminated.

Re-experiencing symptoms
One set of PTSD symptoms involves persistent and distressing re-experiencing of the traumatic event in one or more ways. In these symptoms, the trauma comes back to the PTSD sufferer in some way, through memories, dreams, or distress in response to reminders of the trauma. A more extreme example of this is “flashbacks,” where individuals feel as if they are reliving the traumatic experience. This is a more extreme, less common reexperiencing symptom. PTSD is distinguished from “normal” remembering of past events by the fact that re-experiencing memories of the trauma(s) are unwanted, occur involuntarily, elicit distressing emotions, and disrupt the functioning and quality of life of the individual.

Avoidance and numbing symptoms
A second set of PTSD symptoms involves persistent avoidance of stimuli associated with the trauma, and numbing of general responsiveness. These symptoms involve avoiding reminders of the trauma. Reminders can be internal cues, such as thoughts or feelings about the trauma, and/or external stimuli in the environment that spark unpleasant memories and feelings. To this limited extent, PTSD is not unlike a phobia, where the individual goes to considerable length to avoid stimuli that provoke emotional distress. PTSD symptoms also involve more general symptoms of impairment, such as pervasive emotional numbness, feeling “out of sync” with others, or a lack of expectation for future goals being met, due to their trauma experiences.

Symptoms of increased arousal
This set of symptoms is represented by persistent symptoms of increased arousal not present before the trauma. These symptoms can be apparent in difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, a hypervigililant watchfulness, and/or an exaggerated startle response. Individuals suffering from PTSD experience heightened physiological activation, which may occur in a general way, even while at rest. More typically, this activation is evident as excessive reaction to specific stressors that are directly or symbolically reminiscent of the trauma. This set of symptoms is often, but not always, linked to reliving of the traumatic event. For example, sleep disturbance may be caused by nightmares, intrusive memories may interfere with concentration, and excessive watchfulness may reflect concerns about preventing recurrence of a traumatic event that may be similar to that previously endured.

Required duration of symptoms

For a diagnosis of PTSD to be made, the symptoms must endure for at least one month.