Every year, millions of people are affected by both mass violence and natural disasters, such as earthquakes, floods, hurricanes, tornados, and wildfires. Survivors face the danger of death or physical injury and the possible loss of their homes, possessions, and communities. Such stressors place survivors at risk for behavioral and emotional readjustment problems.

This fact sheet considers three questions often asked by survivors: What psychological problems might one experience as a result of surviving a disaster? What factors increase the risk of readjustment problems? What can survivors do to reduce the risk of negative psychological consequences and to best recover from disaster stress?

What psychological problems might one experience as a result of surviving a disaster?

Most child and adult survivors experience one or more of these normal stress reactions for several days:

• Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities)
• Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame
• Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive
• Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling

Most disaster survivors only experience mild, normal stress reactions. Disaster experiences may even promote personal growth and strengthen relationships. However, as many as one out of every three disaster survivors experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:

• Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember)
• Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks)
• Extreme attempts to avoid disturbing memories (such as through substance use)
• Extreme emotional numbing (completely unable to feel emotion, as if empty)
• Hyper-arousal (panic attacks, rage, extreme irritability, intense agitation)
• Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions)
• Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)

What factors increase the risk of readjustment problems?

Survivors are at greatest risk for severe stress symptoms and lasting readjustment problems if any of the following are either directly experienced or witnessed during or after the disaster:

• Loss of loved ones or friends
• Life threatening danger or physical harm (especially to children)
• Exposure to gruesome death, bodily injury, or dead or maimed bodies
• Extreme environmental or human violence or destruction
• Loss of home, valued possessions, neighborhood, or community
• Loss of communication with or support from close relations
• Intense emotional demands (e.g., rescue personnel and caregivers searching for possibly dying survivors or interacting with bereaved family members)
• Extreme fatigue, weather exposure, hunger, or sleep deprivation
• Extended exposure to danger, loss, emotional/physical strain
• Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)

Some individuals have a higher than typical risk for severe stress symptoms and lasting PTSD, including those with a history of:

• Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, unemployment, or discrimination
• Recent or subsequent major life stressors or emotional strain (such as single parenting)

Disaster stress may revive memories of prior trauma, and may intensify preexisting social, economic, spiritual, psychological, or medical problems.

What can survivors do to reduce the risk of negative psychological consequences and to best recover from disaster stress?

Researchers are beginning to conduct studies to answer this question.  Observations by disaster mental-health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote postdisaster readjustment.*

Protect: Find a safe haven that provides shelter; food and liquids; sanitation; privacy; and chances to sit quietly, relax, and sleep at least briefly.

Direct: Begin setting and working on immediate personal and family priorities to enable you and your significant others to preserve or regain a sense of hope, purpose, and self-esteem.

Connect: Maintain or reestablish communication with family, peers, and counselors in order to talk about your experiences. Take advantage of opportunities to "tell your story" and to be a listener to others as they tell theirs, so that you and they can release the stress a little bit at a time.

Select: Identify key resources, such as FEMA (Federal Emergency Management Agency), the Red Cross, the Salvation Army, or the local and state health departments, for clean-up, health, housing, and basic emergency assistance.

Taking each day one at a time is essential in disaster's wake. Each day is a new opportunity to FILL-UP:

• Focus Inwardly on what's most important to you and your family today;
• Look and Listen to learn what you and your significant others are experiencing, so you'll remember what is important and let go of what's not;
• Understand Personally what these experiences mean to you, so that you will feel able to go on with your life and even grow personally.

* The construct "Protect, Direct, Connect, Select" was developed by Diane Myers, unpublished manuscript.