Natural Disasters, Acute Stress Disorder and Posttraumatic Stress Disorder
Natural Disasters, Acute Stress Disorder and Posttraumatic Stress Disorder
Disasters characteristically occur quickly leaving behind comprehensive physiological and psychological impairment (Fullerton, Robert, & Wang, 2004). Natural disasters specifically are defined by the world health organization (1980) as an ecological phenomenon that occurs suddenly and is of sufficient magnitude to require external assistance, additionally the DSM-IV defines a traumatic event as an event experienced, witnessed or confronted by a person that involves actual or threatened death, serious injury or an threat to the physical integrity of self or others (Sriram, Rodriguez-Fernandez, & Doyle, 2012).
Natural disaster tends to occur in rural areas in Australia and affects a diverse range of social structures and cultures. PTSD is an anxiety disorder that occurs among persons exposed to a traumatic event involving life threat and injury of themselves or those around them (Sriram, Rodriguez-Fernandez, & Doyle, 2012). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), states the core symptoms are impaired concentration, emotional numbing, recurrent flashes of traumatic memories, social withdrawal, and hyper arousal.
PTSD is often observed as a comorbidity of other psychiatric disorders, most commonly depressive or anxiety disorders (Sriram, Rodriguez-Fernandez, & Doyle, 2012). Acute stress disorder displays similar symptomology to PTSD however differs by being a trauma related diagnosis that is made within the first 30 days after the trauma incident (Bryant, 2006).
The DSM-IV requires that at least three of the following five dissociative symptoms were experienced during or after the traumatic event: numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization; or dissociative amnesia (Bryant, 2006). It has been shown that a majority of those who develop PTSD are not affected by ASD however those who do develop ASD tend to go on to develop PTSD (Bryant, 2006).
Natural disasters have been a key focus of research due to widespread damage that includes loss of life, infrastructure, resources, and way of life. In Australia natural disasters take the form of bushfires, floods, severe storms, earthquakes and landslides all which display their own various consequences. As is the nature of PTSD different rates and severity of PTSD is seen. In response to the 1983 Ash Wednesday fires in Australia a rate of 53% of people reported PTSD diagnosis whilst after the 2004 tsunami in Thailand prevalence was 12% and dropped to 7% after nine months (Bryant, 2009).
A current perspective is shown in a Queensland government publication where over 100,000 Queenslanders aged 18-64 are expected to experience a mental health problem in the 2 years following the 2010-2011 floods (Bryant, 2009). Effects of trauma A majority of those exposed to a traumatic event will experience an acute temporary psychological disturbance and over time will result in minimal functional impairment (Adams, & Boscarino, 2006; Sherin, & Nemeroff, 2011). However PTSD affects memory and attention problems in everyday lives alongside chronic anxiety, tension and health problems (Shoef, & Rotiman, 2000).
Those with PTSD have an inability to forget and are hyper vigilant to stimuli associated with the traumatic event due to an attentional bias (Sherin, & Nemeroff, 2011). PTSD in regards to the neuroendocrine systems involves the hypothalamus-pituitary-adrenal (HPA) axis and it has been proposed that its hypersensitivity results in a lower cortisol levels at the time of trauma (Sherin, & Nemeroff, 2011). High stress intensity and negative feedback loops in the HPA axis may cause the hyper-sensitive neuro-endocrine axis that brings about biochemical response to severe stress (Sherin, & Nemeroff, 2011).
This negative feedback is caused by glucocorticoids. A sustained exposure to glucocorticoid is associated with an impairment, loss of dendric spines, reduction in dendric branching all of which results in damage to hippocampal neurons and reduced volume of the hippocampus is seen in those with PTSD (Sherin, & Nemeroff, 2011). Neurochemichally those with PTSD display a maladaptive regulation of catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitters, which are found in brain circuits that regulate stress and fear responses (Sherin, & Nemeroff, 2011).
Structurally it is found, in PTSD, a reduced volume of the hippocampus, frontal cortex (Sherin, & Nemeroff, 2011). One of the three overall symptoms of PTSD is avoidance which has profound impact on the social lives of sufferers. The degree of exposure and amount of change to personal circumstances dictate the severity of overall wellbeing, on a biological, psychological and social level (Sherin, & Nemeroff, 2011). Recovery from trauma
There are several processes to recovery from trauma and all are subjective to the actual trauma, the characteristics of the person and the community/environment in which they live (Benedek, Fullerton, & Ursano, 2007; Adams & Boscarino, 2006). There is no gold standard intervention for optimal trauma recovery rather there is an amalgamation of methods used to empower the sufferer to control their recovery on an individual level and with respect there circumstance and population (Herman, 1998).
In the short term after the trauma it has been shown that those who are debriefed after a natural disaster a more likely to develop PTSD; this is linked to the theory that debriefing confirms the negative adaptation to trauma (Reyes, & Elhai, 2004). It is instead suggested that information about normal symptoms and access to professional services are there for those who want to pursue it additionally media regulation suggested (Reyes, & Elhai, 2004; Shoaf, Rotiman, 2000). Furthermore studies show that a strong network of family, friends and a community as a whole are important for deterring PTSD (Silove, & Zwi, 2005).
In terms of the professional help therapies such as cognitive behavioral therapy has been shown to be effective across cultures and settings (Reyes, & Elhai, 2004; Kar, 2011). It has been implemented by community therapist after brief training, individually or as a group and has been shown to be successfully implemented over the internet (Reyes & Elhai, 2004). Exposure treatment can be implemented by gradually exposing the person to their fears from less severe to intense fear with the goal of extinguishing the fear response in reaction to the stimuli. Exposure therapy focusses on the memories and external reminders of the traumatic event.
Imaginary and virtual reality technology can be used to implement exposure therapy when direct exposure to the stimuli is not possible (Reyes & Elhai, 2004). Critical incident stress Management (CISM) is commonly used with those indirectly affected by trauma such as rescue workers. It involves pre-incident training, one on one support, information about coping and stress to large group, small group interventions and a family support component (Reyes, & Elhai, 2004). Psychological first aid (PFA) is used to initially reduce symptoms of distress and the short term and long term adaptive functioning.
It does this by addressing eight components; (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping support, and (8) linkage with collaborative services (Reyes, & Elhai, 2004). It is intended for use by those who provide immediate support for survivors and its main advantage is that its principles can be applied anywhere (Reyes, & Elhai, 2004). Cognitive restructuring involves relearning thoughts and beliefs associated with the negative interpretation of the traumatic event (Reyes, & Elhai, 2004).
EMDR is based on the combination of using imagery exposure and reprogramming of brain function through induction of saccadic eye movements (Reyes, & Elhai, 2004). Pharmacological interventions are advised only to be used in the first four weeks of evident symptoms if they cannot be managed by psychological means (Reyes, & Elhai, 2004).. Medications that can be used are serotonergic reuptake inhibitors (SSRIs), morphine and glucocorticoids (Reyes, & Elhai, 2004). Morphine has been shown in several studies of hospitalized patients to be an effective deterrent in developing PTSD.
It works by reducing pain which can be traumatic in itself, however a role for morphine in the absence of physical pain is not clear (Reyes, & Elhai, 2004). Several studies have shown the administration of glucocorticoids during or shortly after the trauma resulted in exposed being less likely to develop PTSD this is related to the low cortisol and negative feedback loop in the HPA axis after trauma (Reyes, & Elhai, 2004). Although several naturalistic studies initially suggest there benefit Glucocorticoids have not been established by enough evidence (Reyes, & Elhai, 2004).
SSRIs are the most common drug used in the treatment of PTSD and has been shown to be modestly effective in civilian based trauma (Reyes, & Elhai, 2004). Long term actions and recommendations It has been shown that many who are exposed to trauma will over time regain their original functioning however there is a small percentage who will continue to experience Long term actions in the research has a strong focus on community strategies as a whole (Shoaf, & Rotiman, 2000). Long term action should involve monitoring those who are considered high risk for developing psychological disturbance, PTSD, depression or anxiety.
Many people do not display chronic symptoms until well after the traumatic event, even the anniversary can be the first trigger. Ongoing support and access to professional sources from within the community following the initial education about all reactions to disaster is the core concept of disaster recovery (Gortner, & Pennebaker, 2003). One important factor in the ongoing support is the reduction of stressors that can affect the survivor for years to come such as financial difficulty, employment, and housing. Resilience is defined as the ability to return to your original state and to withstand stress and catastrophe (Raphael, & Ma 2011).
Studies show that increasing perceived self-efficacy, social capital and individual awareness are important predictors for resilience after trauma (Raphael, & Ma 2011; Raphael, & Ma 2011) Long term actions should focus on prevention, preparedness, recovery and resilience to not only diminishes the direct consequences of natural disaster but the severity of pervasive psychological disorders such as PTSD, depression and anxiety (Boon, Cottrell, King, Stevenson, & Millar, 2012). A reoccurring theme in recovery from natural disaster is the importance of integration from psychological, social and individual paradigms.
University/College: University of California
Type of paper: Thesis/Dissertation Chapter
Date: 27 November 2016
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