Reactions to Acute Trauma: 9/11 and Beyond
On September 11, 2001, Americans found that their sense of safety, comfort, and control over their lives had been shattered. The acts of terrorism of 9/11 made all of us victims of a collective trauma. Whether we are surviving employees of the World Trade Center (WTC) or the Pentagon, bystanders who physically witnessed the events, family members who lost loved ones in the disasters, or simply part of the masses frozen in front of televisions watching horrific replays of that day, we are all survivors and witnesses to an overwhelming traumatic event. We became directly, concretely aware, as individuals, as a society and as a culture, of vulnerability, as well as resilience, in the face of trauma. Many experienced severe acute reactions to stress for the first time. Others found this to be just one more traumatic, distressing event in their lives. All of us became potential casualties of persistent disorders related to extreme stress such as Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD). Other long-term complications of severe stress include anxiety, depression and other mood problems, and substance abuse.
Once thought of as conditions that only plagued veterans of war (hence, labeled “shell shock,” “combat neurosis” or “battle fatigue”), stress disorders now are known to potentially affect any persons exposed to life-threatening dangers to themselves or others. These are serious mental health conditions that can affect people of any age. Research studies estimate that as many as 70% of adults in the United States have experienced a traumatic event at least once in their lives. Twenty to 30 percent of these traumatized individuals go on to develop PTSD. An estimated five to 10% of Americans– at least 13 million–have PTSD at any given time. Research suggests that PTSD is among the three or four most common mental illnesses in North America.
Individual reactions to traumatic events like those of 9/11 vary considerably. There is a spectrum of normal acute reactions to trauma, some of which parallel those of the grief caused by loss of a loved one. Normal responses to trauma in adults and children are found below. It is important to note that these are normal responses to abnormal events and not signs of being “crazy.” These symptoms may range in severity, intensity, and longevity in different people. However, most acute normal trauma responses resolve within one to three months, although long-term minor symptoms may persist indefinitely. For example, an attorney whose partner was shot at work heard the sound of people running and shots being fired before he emerged from his office to administer CPR to his dying friend. Fifteen years after the event, he still feels jumpy and anxious if he suddenly hears people running behind him, although he has no other symptoms of a stress disorder.
Trauma challenges one’s sense of safety and control in the world. One feels more vulnerable and uncertain about life being safe, orderly, and predictable. Assumptions that good triumphs over evil, that God looks out for the innocent, that right and fairness will prevail, may be damaged. Trauma may lead people to challenge their values and beliefs, even change life direction.
It is not known who among those experiencing a traumatic event will go on to develop PTSD or other severe psychiatric conditions, such as depression, as a result. Something occurs during the several months after a trauma so that the person’s body and mind develop a series of intense, unwanted automatic reactions to reminders of the event including panic, recurrent severe nightmares, intrusive recollections, flashbacks, intense jumpiness, irritability, preoccupation with trauma, and poor concentration. Other PTSD symptoms include numbing of emotions, avoidance of reminders, withdrawal from others, memory loss relating to the traumatic event (dissociative amnesia), depression, sadness, guilt, shame, suicidal and self-destructive thoughts and acts, and physical symptoms without apparent medical cause.
Risk factors for developing PTSD after a traumatic event include having been previously traumatized; life-threat during the trauma; prolonged, multiple violent and/or assaultive traumas; witnessing grotesque effects of trauma on others, such as people jumping from the World Trade Center; prior psychiatric disorder; poor social supports; dissociation (numbness, out of body experiences, visual changes, time distortion, memory loss) at the time of the trauma, and certain physiological reactions at the time the trauma occurs.
For most people, the acute stress reaction diminishes gradually with time. Most trauma experts recommend that people avoid isolation and attempt to share reactions with friends, family, and co-workers. After a trauma, it is important to continue normal routines, if possible, especially those that relate to health such as exercise, diet, and maintenance of a normal sleep cycle. It may be tempting to numb oneself with alcohol or drugs, but this is likely to postpone long-term resolution of the trauma reaction.
Children Need Reassurance
Children may have a variety of responses depending on their age, prior history of trauma or psychological problems, family stability, and trauma reactions in their parents or caregivers. Some of these are listed below. After a traumatic event, it is particularly important to help children maintain normal routines of school and family life, if possible. Children may have different needs for reassurance about the trauma at different ages. Young children may misunderstand the situation. It is important to attempt to respond to what your child is actually asking. Try to ascertain what the child understands has happened so that you can correct misinformation the child may have acquired.
It may be difficult for parents to fully reassure a child, especially if they are overwhelmed themselves. However, assurance that the parents will work to help and protect the child is important, even if they can’t explain why such bad things happen and that they may happen again.
Professional help is warranted for trauma-related symptoms if they do not diminish over time, particularly if they interfere with normal endeavors of life: work, school, relationships, and other activities of living. Treatment for PTSD and related disorders includes individual, group, and family therapy, as well as medications.
As a society, we value self-reliance and emotional self-sufficiency, often expecting that we can “put it behind us and move on” in the face of overwhelming trauma. In reality, no amount of personal or professional competency can prepare someone for the potentially devastating effects of experiencing or witnessing trauma.
Richard J. Loewenstein, M.D.,
Kristen Wilson, M.A.,
SHEPPARD PRATT TRAUMA DISORDERS SERVICES
Normal Reactions to Trauma
- Phobias, anxiety, over-reaction to non-traumatic stimuli
- World-weariness, tiredness
- Increased startle reaction
- Can’t get it out of one’s mind
- Reminders trigger a reaction
- Jumpiness; easily startled
- Sadness, depression, tearfulness, mood swings
- Increased irritability, anger
- Other problems seem more overwhelming
- Difficulties with sleep
- Inattentive to health needs; exercise less, eat more, drink more
- Intrusive recollections, images, dreams, nightmares
- Intrusive thoughts of one’s other painful or traumatic experiences
- Numbness, disbelief
- Feeling out of one’s body
- Decreased trust, sense of safety about the world
- Uncertainty about the future
- Avoiding reminders of trauma
(Vary with age, experience)
- More anxiety, fear, worry
- More clinginess
- Fear of death, harm to family, self
- Trauma themes appear in play
- Jokes or other ways of avoidance (especially in adolescents)
- Bad dreams, troubled sleep
- Inability to understand
- School problems
- Avoidance of reminders
- Sadness, unhappiness
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