In the immediate aftermath of any trauma, a majority of survivors will experience some form of psychological distress. Authorities in the field of trauma distinguish the effects of intense short-term trauma exposure.
Most survivors of a shocking event will develop some stress-related symptoms such as feeling frightened, jumpy, and easily startled. The survivor's sleep may be fretful, concentration becomes impaired, and assumptions about personal safety are replaced by uncertainty. While these symptoms may create turmoil, shock, and even confusion, they are common and usually have a benign outcome.
The book "Identifying and Recovering from Psychological Trauma" describes the importance of empathy, communal bonding, and reassurance that safety has been re-established as serving a restorative function in the natural healing process.
In contrast, a minority of trauma survivors experiences a dramatic disruption of their state of awareness; this dissociative state refers to a shift in the survivor's integrated flow of consciousness and synthetic brain function.
If, in addition to this, the individual has flashback symptoms, marked anxiety or vigilance and attempts to run away from ("avoid") anything (even thoughts), that remind him of the experience, one calls this "Acute Stress Disorder". These symptoms usually occur if you were directly exposed and threatened by a horrifying event.
These symptoms are obviously more serious than the "stress related symptoms" of being afraid and worried. If the symptoms described above, under "acute stress disorder", persist beyond four weeks, the trauma- effect has probably evolved into that of post-traumatic stress disorder (PTSD).
An example of high intensity short-term trauma would be living in New York at the time of the Twin Tower Terrorist Attacks of September 11, 2001:
A few days after the September 11 terrorist attacks, 44 percent of a nationally representative sample of adults reported high levels of stress in at least one of five substantial stress categories, while 90 percent reported at least some levels of stress.
These findings of traumatic stress symptoms stretched across the entire nation.
However, the closer one lived to Lower Manhattan, the more likely would one suffer from significant stress symptoms. Those who spent many hours each day watching the event on television also developed stress reactions, even though they personally experienced no direct threat to their lives; the so-called "vicarious stress syndrome".
While a majority of residents in New York experienced substantial stress levels in the weeks following their terrorist attacks the New York Academy of Medicine reported a prevalence rate for full PTSD of only 7.5 % after 5 to 8 weeks and only 0.6 % after 6 months.
At the epicenter of a terrorist attack, 90 percent of surviving victims may exhibit some adverse psychological reaction in the hours and days following the critical event. While the frequency of psychological distress dissipates as one moves in time or distance from this epicenter, a small but significant percentage of previously healthy individuals continue to bear significant distress. These findings have been demonstrated in demographic studies conducted with local and national populations exposed to trauma imagery. Following the September 11th terrorist attacks, for example, national surveys of stress reactions identified substantial symptoms of stress in Americans across the country (Schlenger et al., 2002, and Schuster et al., 2001).
These findings were duplicated by the clinical trials conducted after the Madrid and London train and bus bombings.
Follow-up studies of trauma survivors demonstrate that victims, over time, "habituate," developing a certain tolerance or diminution of most symptoms. However, a small but significant percentage of such individuals, however, remain in a state of hyper-vigilance, and are distressed by the visitations of traumatic recollections or "flashbacks". Furthermore, in an unconscious attempt to shield them against further trauma triggers, such victims often engage in a variety of avoidance behaviors. This, in itself, can become quite disabling.
The severity and duration of the trauma, the victim's age, their support system, previous exposure to trauma, and other factors will determine the severity and outcome of these symptoms.
"Acute Stress Disorder" is a more serious response to a shocking violation or near-death experience. It will begin within hours or days' following a traumatic event and the victim suffers a combination of dissociation as well as the full-blown spectrum of post traumatic stress symptoms.
This is not common. Some scholars believe that this is just the first glance of what will become PTSD. Others believe that a shock state like the one I described may still "habituate" given the right social and emotional supports. Most authorities in the field would pose that "narrative" or "exposure" form of therapy would be required, allowing the trauma to be "processed", in order to ward off PTSD.
In fact, there are many other factors that will determine the course of "acute stress disorder". These include age, the duration of the stress, whether the individual has been previously traumatized, and the availability of supportive resources.
But if left untreated, about fifty per cent of trauma victims suffering from "Acute Stress Disorder" will later show signs of PTSD.
In this group of more traumatized victims, psycho;ogical treatment of some kind is often required and is usually successful.
Victims of "Acute Traumatic Stress Disorder" may experience dissociation that is so severe that the individual may present in a trance-like state referred to as "dissociation".
The Emergency Room at SUNY Downstate, Brooklyn, had been designated as a Disaster Treatment Center within hours after the 9/11 Terrorist attacks. As the Attending Psychiatrist on call, I evaluated several patients rescued from the Twin Tower buildings.
One young woman had been walking down the stairwell when she heard a tremendous explosion. She quickened her pace until she smelled fumes and heard screaming. At that point she opened the door and stood on a small platform (all that remained of that floor).Immediately, a burning tire came hurtling down, missing her by inches. As she gazed up, she saw above her the remnants of offices, disconnected from their main landing, like suspended islands. Injured and burning survivors, assured of their pending doom, could be seen screaming in pain and terror.
The woman paused before realizing that their fate was sealed, and then continued down about another forty floors until reaching the exit. She remained in the chaos at "Ground Zero" for a short time and then followed a crowd of people walking across the Brooklyn Bridge. Several hours later she arrived home in a "dazed state". Her mother brought her to the Emergency Room the following morning. She had paced the floor of her apartment the entire night without sleeping.
On evaluation, what one observed was a young woman who was staring blankly in front of her. She was quietly moaning and sobbing. She was still totally immersed in the trauma scene as if it were occurring that moment. Not only did she not answer questions, she didn't even notice my presence in the room. From time to time she would reach or call out to the victims still visible in front of her. On several occasions she raised her hands to shield herself against falling debris.
This is the most extreme form of dissociative reaction, where the victim was so fixated to the scene of the trauma, that the "present moment" in time did not exist.
For such catastrophic reactions, the priority is to re-anchor the individual's consciousness in the present.
The therapeutic priority is to establish a safe and familiar, environment for the survivor: In other words, the most effective intervention is to re-establish a world that is once again safe and predictable.
Bearing that in mind I chose not to admit the patient to a noisy, hectic psychiatric unit.
Instead, I recommended that her mother take her home to her room, dim the lights, play soft music, and take off several days from work to be at her side. I suggested that she gently try to engage her, periodically, but screen her against unnecessary intrusions such as T.V. or even the telephone. At the same time I prescribed minor tranquillizers to lower her arousal levels. (She was in a perpetual state of heightened arousal, hence the pacing, moaning, and inability to sleep.)
