The devastation in Joplin, Missouri is all over the news today. Photos of entire blocks wiped out, stories of people who have been injured, lost loved ones, sustained severe property damage permeate our awareness and generate our thoughts, prayers, and desire to help in any way we can. I want to address the feelings that come up around a tragedy, and ways of coping in the midst of chaos.

As far back as the 1800's, symptoms that appeared soon after traumatic stress were noted and called "shell shock." In some of the writings from that time, the condition was referred to, poignantly, as “Soldier’s Heart.” Years later, we now call those signs Acute Stress Disorder, and it can affect anyone who has experienced an unusually severe traumatic event. Symptoms of Acute Stress Disorder appear anywhere from immediately after the traumatic event to four weeks later (after four weeks, it might be categorized as Post Traumatic Stress Disorder – more on PTSD later in this article). Some of the signs of Acute Stress Disorder include:

Feeling detached or numb. "I feel like I am in a daze."

Re-experiencing the event in flashbacks, dreams, or thoughts

Inability to remember some or all of the event

Emotional distress when remembering the event

Emotional distress for seemingly no reason “I just feel really angry, out of the blue.”

Avoidance of anything that reminds of the trauma – places, people, discussions

Anxiety: worry, irritability, inability to concentrate, sense of helplessness, restlessness

Hyperarousal: insomnia, increased startle response, hypervigilance

Physical symptoms, such as stomach upset, headaches, and muscle tension

Additionally, if you have been involved in an acute stress event, you may feel guilty that you survived, or experience a sense of overwhelming need to do more to help.

The responses listed above are the ways we cope with unimaginable stress. Our hearts and minds are overloaded with fear, worry, and sadness. We are thrust into a sense of terrifying vulnerability, and we develop coping mechanisms, even unconscious ones, to survive the immediate aftermath of a disaster.

A person may experience none, some, or all of the above signs of Acute Stress Disorder following a tragedy. Their distress may be immediately apparent to those around them, or the person may hold these feelings inside, not showing their pain to the world. Whatever way Acute Stress Disorder presents itself, help is available.

What can you do to help yourself or your loved ones when dealing with a traumatic event? Here are some ideas:

Reach out to your friends, family, and any available support services. Don't isolate. Your support system is vital right now. If the idea of reaching out is overwhelming, at least allow them in.

Know that your feelings are a normal reaction to a severe stressor. Yes, you would prefer not to be in distress, and there is help available to get you there. But initially, be kind to yourself and know that your reactions are to be expected right after a trauma.

Control what you can: Immediately after a disaster, it feels like everything is out of control. When you can, find 5 minutes to breathe, eat something, disengage for just a moment from the news channel. Sleep if you can.

Seek help: whether it is the support of loved ones, people who experienced the same traumatic event, or making an appointment with a therapist trained in trauma – help is out there. You are not alone.

Post Traumatic Stress Syndrome (PTSD)

What is the difference between PTSD and Acute Stress Disorder? In a nutshell, time. The Diagnostic and Statistical Manual (DSM) defines Acute Stress Disorder as occurring between two days and four weeks after a traumatic event. When the symptoms described earlier continue on (or first appear) after four weeks, a diagnosis of PTSD is likely.

My friend, author Jim Orrill, shared this with me this morning; I thought it fit this article and the thoughts of those of us far away from Joplin. We stand with you, and send our love and prayers.

"We look for the monster under your bed and we let you know that everything’s safe and you‘re going to be all right, guiding you through these first scary things. Because we know there’s a whole worse world of scary things out there that we’d trade for monsters in a heartbeat. So we’ll get the flashlight and check the closets and look under the bed and give you the all clear. We’ll do a good job, too. We won’t just pretend to look. We still remember what is was like to see the monster, so we’ll be thorough. And then we’ll tuck you in, remind you that we‘re right down the hall, and kiss you goodnight."

Links and Resources Online

American Psychological Association: [Link Removed]

Narrative Therapy – San Diego – Erin Falvey, MFT: [Link Removed]

National Institute of Mental Health: [Link Removed]

Psychiatry Online: [Link Removed]

Trauma Pages: [Link Removed]