Mental Health Matters: Air Disasters and PTSD
M. Regina Asaro, M.S.,R.N.,C.T.
Although much of the impetus to study posttraumatic stress disorder (PTSD) came out of work with Vietnam veterans, it is now understood that you need not have been in a war to have it. This column will explore posttraumatic stress reactions after an air disaster and how they can interfere with the grieving process.
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV, American Psychiatric Association, 1994), people at risk for posttraumatic stress disorder are those who have experienced an “actual or threatened death or serious injury” to themselves, witnessed such an event or learned about an “unexpected violent death, serious harm or threat of death or injury experienced by a family member or close associate” (p.424). I have quoted out of the manual because it accurately describes the event experienced by a person who has survived a plane crash or who has lost a loved one as a result of a crash. There are three main types of posttraumatic stress responses:
- Reexperiencing the Event – Here, an individual may have recurring, possibly intrusive, memories of the event or experience flashbacks, dreams and/or nightmares.
- Persistent Avoidance – An individual will deliberately avoid anything associated with the trauma–mainly because any reminder is accompanied by high feelings of anxiety. At the same time, there is often a “numbing” of other emotional responses.
- Increased Arousal – This has to do with a persistent sense of alertness, as though one is continually on guard. There may be difficulty falling or staying asleep, an exaggerated “startle” response and/or heightened feelings of anger or irritability.
These reactions may appear immediately after the trauma or develop later; however, in order for the diagnosis of PTSD to be made, all three reactions must be present for at least a month and must cause “clinically significant distress or impairment in social, occupational or other important areas of functioning” (DSM-IV, p.424). If criteria for PTSD are not met, an individual may meet criteria for other anxiety disorders, such as Acute Stress Disorder; in other words, whether or not a diagnosis of PTSD is warranted, there can still be a great deal of distress when one or more of these reactions are present.
It is also possible for these reactions to exacerbate each other. For example, if a person were having nightmares, it would be difficult to fall asleep; if a person is not getting adequate rest, then the other reactions feel even more intense. Untreated, they can easily interfere with an individual’s ability to maintain functioning at home, work or school.
Recent research has greatly expanded what is known about PTSD. It has been shown that traumatic memories are processed and stored differently than “normal” memories. Very often odors (such as burning aviation fuel) or sounds (like explosions), which one might have experienced as a part of the original event, are bound to this traumatic memory; later, those smells or sounds may trigger posttraumatic stress responses.
Stress reactions usually cause a cascade of substances (including adrenaline) to be released; these, in turn, sometimes go into a feedback loop where physiological reactions take on a life of their own. When this happens, high levels of anxiety and/or panic may be experienced, unrelated to whatever might be happening in the present, and maybe without an identifiable cause. These reactions are usually difficult to control without professional assistance.
That is posttraumatic stress disorder in a nutshell although, as noted earlier, it can be present along grief reactions. However, these stress reactions might easily interfere with a person’s ability to grieve because, to do effective grief work, one must closely examine what happened and deal with each facet of the loss. After a traumatic loss, however, the nature of the stress reactions may make it all but impossible for the person to concentrate on this griefwork. That is why, for many people, the trauma must be dealt with before they can begin to grieve.
Conclusions
It has been very difficult to try to summarize the important aspects of PTSD in such a short column, given how much has already been written about it. However, the way that traumatic memories are stored in the brain and the resultant impact on the rest of the body often cause people to feel overwhelmed and confused–because other losses have not made them feel this way.
Especially after a trauma, people try to understand how such a thing could have happened. Sometimes it is easier to put the blame somewhere, anywhere, in an effort to make sense of what has occurred. When this happens, people may make negative self-judgments (e.g., self-blame, self-criticism) because of the circumstances and the reactions they are having. If so, cognitive therapy is often helpful in teasing issues and concerns apart and may help you to understand more completely what happened and why you reacted the way you did when the disaster first occurred and since.
Although researchers are not completely sure how they work, therapies such as EMDR (Eye Movement Desensitization and Reprocessing) and Thought Field Therapy have provided relief to many people experiencing posttraumatic stress reactions. These are painless and non-intrusive therapies that can be done in a therapist’s office. Additionally, there are medications which can make you feel comfortable enough emotionally and physically so that you can go about your daily routine and begin to work through the trauma and grief; these need not necessarily be taken forever. If you find that you are having any (or all) of the reactions described above, it is important that you understand that these stress responses are normal reactions to an “abnormal situation” and I urge you to seek out a trained trauma counselor.
In this column, we have looked at posttraumatic stress reactions and how they can interfere with the grieving process. The next column will go into the grieving process in greater detail.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Association.
M. Regina Asaro, MS, RN, CT of Newport News VA, a consultant on traumatic loss issues, may be contacted at rasaro68@peoplepc.com
© Copyright 2003, M. Regina Asaro, MS, RN, CT. The above may be copied in part or in its entirety with acknowledgment of the author and its source.
