Effects of Mass Tragedies

10/03/2017

Healthy Living – October 3, 2017
Amy Movius, MD, Eastern Maine Medical Center
 dr-movius.jpg
Most people have heard of PTSD – Post Traumatic Stress Disorder.  It is a condition that describes the ongoing toll, body and mind, taken on those who have experienced severe trauma.

Secondary Traumatic Stress – or STS –has also been long recognized. This condition is similar to PTSD except if affects individuals who are close to or have witnessed someone else’s trauma. Historically, children in homes with domestic violence, healthcare workers and emergency responders, as well as law enforcement personnel were typical of people at risk for STS.

The increasing presence of and access to mass media has expanded the scope of potential secondary trauma. Unfortunately there has been no lack of tragedy of late: mob clashes in Charlottesville, hurricane devastation on multiple fronts, and now a mass shooting in Las Vegas with greater than 50 people dead.  Though it’s been less than 48 hours since the last occurred, it would be hard to find someone who hasn’t seen cell phone videos of terrified people running with a steady stream of gunfire clearly audible in the background. Discussing the expected signs and symptoms of traumatic stress responses seems prudent in this context.

As the tables listed at the end of this article show, the effects people may experience after a trauma are wide-reaching and the disturbances can infiltrate all aspects of life. It is important to remember that though these reactions are unpleasant, they are normal.  Also, there are some silver linings that follow the aftermath of such events. “Post traumatic growth” is one term that attempts to capture this concept.   These include increased resilience, coping, and increased altruism.  In short, the worst events can also bring out the best in our humanity.

Most people fully recover from traumatic stress reactions, though it may take months to even a year or more.  Some may develop more severe symptoms and need help from professionals to recover.   Symptoms that should raise concern are included below.  They generally are more exaggerated and extremes forms of normal responses.
  1. Severe Dissociation (world feels unreal)
  2. Severe intrusive re-experiencing
  3. Extreme avoidance/withdrawal
  4. Severe hyperarousal (example is panic attacks)
  5. Debilitating anxiety (phobias, obsessions)
  6. Severe depression
  7. Problematic substance use (self – medication)
  8. Psychotic symptoms
Certainly, those who are traumatized first hand are most at risk for having persistent problems from a stress disorder.  Still, at this point in our country we may all be at risk of secondary trauma.  Being familiar with normal stress response symptoms and being gentle and patient with ourselves and others will hopefully see us individually and collectively through these difficult times.

Common traumatic stress reactions (modified from Disaster Mental Health Response Handbook, p. 28)
Emotional Effects Cognitive Effects Physical Effects Interpersonal Effects
Shock Impaired concentration Fatigue, exhaustion Increased relational conflict
Terror Impaired decision making ability Insomnia Social withdrawal
Irritability Memory impairment Cardiovascular strain Reduced relational intimacy
Blame Disbelief Startle response Alienation
Anger Confusion Hyperarousal Impaired work performance
Guilt Nightmares Increased physical pain Impaired school performance
Grief or Sadness Decreased self-esteem Reduced immune response Decreased satisfaction
Emotional Numbing Decreased self-efficacy Headaches Distrust
Helplessness Self-blame Gastrointestinal upset Externalization of blame
Loss of Pleasure derived from familiar activities Intrusive thoughts/memories Decreased appetite Externalization of vulnerability
Difficulty feeling happy Worry Decreased libido Feeling abandoned/rejected
Difficulty experiencing loving feelings Dissociation (e.g., tunnel vision, dreamlike or “spacey” feeling Vulnerability to illness Overprotectiveness
 
  1.  PTSD:  National Center for PTSD.  Effects of Traumatic Stress after Mass Violence, Terror, or Disaster.  US Department of Veteran’s Affairs
  2. Secondary Traumatic Stress in the General Public Following Disasters:  A Personal Experience.  Policy Research Associates Blog, January 23, 2013