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Stress disorder after Katrina

Stress disorder after Katrina

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Published by zoe

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Published by: zoe on May 04, 2010
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January 200618
For a week the country watched HurricaneKatrina,packing 160 mph winds,move slowlytoward New Orleans with an expected landfall as aCategory4 or 5 sometime Monday morning,August 29.About1.3 million persons live in NewOrleans and itssuburbs,and many began evacuatingbefore Sunday morning;others waited to seewhether the storm would turn as storms had donein the past seasons.
BySunday evening,nearly 1million persons had fled the city and its surroundingparishes.Between 20,000 and 25,000 othersremained in the city and sought shelter in theLouisiana Superdome,lining up for what theythought would be an uncomfortable but bearable 2
Posttraumatic StressDisorder 
All who viewed the horror caused by Hurricane Katrina could see the reactions of terror,paralysis,loss,and grief.For those who lived through the event itself,these same symptoms are often con-tinued as the survivor relives the horror over and over again.Posttraumatic stress disorder (PTSD)is a psychological and physical reaction to a stressful event that any of us might face,whether welive through it or just witness it repeatedly on television.But emotional distress differs from post-traumatic stress disorder.Why do some persons suffer more extensively? How do you tell whensomeone has PTSD? How can you help? The lessons learned in the aftermath of this terriblenatural disaster may be applied to many other situations for patients or providers alike.
 posttraumatic stress disorder,emotional distress,numbness
Jacqueline Rhoads,Faye Mitchell,and Susan Rick 
Continuing Education
Posttraumatic Stress Disorder 
to 4 days.
Approximately 20,000 stranded tourists weretold to remain in the city’s hotels,on third-floor levelsor higher,and away from windows.
Any hopes of evac-uation out of the city were clearly impossible.Two days after the hurricane a reporter from FoxNews correctly estimated the death toll in the thou-sands and the damage higher than $200 billion,toppingHurricane Andrew as the most expensive natural disas-ter in US history.
More than a million persons hadbeen displaced—a huge humanitarian crisis unseen inthe United States since the Great Depression.
No largeAmerican city had ever been evacuated sinceRichmond and Atlanta in the Civil War.
The people who directly experienced the hurricane’seffects can be seriously affected by the storm’s psycho-logical effects.Many of these people have now beendisplaced from their homes and are being cared for innew communities.Although these people will suffer themost,some other persons who only witnessed theeffects of the hurricane repeatedly on television mayalso be at risk of posttraumatic stress disorder (PTSD).They all may encounter behavioral and emotional read- justment problems that are normal responses to thehurricane’s aftermath.Their exposure to the stress of the storm can change their focus and create confusionabout what they need to do.
How serious these effectswill be depend onsuch things as each person’s overallability to cope with stress,how serious the traumaticevent was,and what kind of help and support he or shegets from family,friends,and professionals followingthetrauma.
Most survivors will think the feelings they have areindications they are having a nervous breakdown or thatthere is something wrong with them because other persons who experienced the same trauma do notappear to be experiencing the same feelings.Somemayturn to drugs or alcohol to make them feel or restbetter.Others may turn away from friends and familywho do not seem to be as affected or understand whatthey are feeling.
The Katrina survivors from New Orleans faced notonly the danger of death and physical injury but also theloss of their homes,possessions,and communities.Manywere separated from their families and were moved toshelters far away from the life that was familiar.Even before the hurricane,New Orleans wasrecorded in the
Louisiana Health Care Report Card 
as acity with many poor,impoverished persons.Manyenvironmental,social,and economic factors contributeto the ranking of New Orleans and the State of Louisiana at the top of the charts of poor health out-comes.
The median family income for New Orleansresidents is $22,276.
Approximately 34% of familyhouseholds are at or below the poverty level.
In theentire state,one in three children lives in poverty.
InNew Orleans,that number changes to about one intwo.
Ninety-seven percent of Louisiana parishes aredesignated as either totally or partially medicallyunderserved.
Hurricane Katrina only added to the stress of thepoor,for they were the ones most affected.They were theones stranded on the overpasses,roofs,and in theSuperdome and Convention Center without food or water.They were the ones who became overwhelmedwith fear and a sense of hopelessness.Unfortunately,these also are the persons who mostlikely will mentally and physically reexperience the trauma.These feelings make them more susceptible to PTSD.
PTSD is different from most mental health diagnoses inthat it is tied to a particular traumatic life experiencethat typically involves the potential for death or seriousinjury.
Several types of experiences and the percentageof survivors who develop PTSD are listed in Table 1.These experiences result in intense fear,helplessness,or horror.It is reasonable to expect that many of thosemost affected by Hurricane Katrina will have one or more of the common stress reactions for several days andpossibly weeks (Box 1).
Patients may experience tem-porary psychological reactions,cognitive reactions,phys-ical complaints,or changes in psychosocial behavior thatcause them to avoid large crowds or social activities atwhich they may be asked about the event.
Work isoften impaired or the person calls in sick to avoid anychances for recall.
Most who were affected by Hurricane Katrina willmost likely experience only mild,normal stress reac-tions.The literature
documents that in manyinstances disaster experiences can promote personalgrowth and strengthen relationships.However,one of every three persons who experienced this disaster will
January 200620
have symptoms that are more than the normal stressreactions—what is called PTSD.
By just watching the television the first few days after Hurricane Katrina,it is evident that the experiences of New Orleans residents place them at a higher than nor-mal risk of severe stress symptoms and lasting PTSD.Other persons who watched the event repeatedly on tel-evision also feel a sense of hopelessness,shock anddespair.This is especially true if they have had a history
Box 1.Common Symptoms of Reactions to Traumatic Stress
 Emotional Reactions
ShockTerror IrritabilityBlameAnger GuiltGrief or sadnessEmotional numbingHelplessnessLoss of pleasure derived from familiar activitiesDifficulty feeling happyDifficulty experiencing loving feelings
Cognitive Reactions
Impaired concentrationImpaired decision-making abilityMemory impairmentDisbelief ConfusionNightmaresDecreased self-esteemDecreased self-efficacySelf-blameIntrusive thoughts or memoriesWorryDissociation (eg,tunnel vision,dreamlikeor “spacey”feeling)
Physical Reactions
Fatigue,exhaustionInsomniaCardiovascular strainStartle responseHyperarousalIncreased physical painReduced immune responseHeadachesGastrointestinal upsetDecreased appetiteDecreased libidoVulnerability to illness
Psychosocial Reactions
Increased relational conflictSocial withdrawalReduced relational intimacyAlienationImpaired work or school performanceDecreased satisfactionDistrustExternalization of blameExternalization of vulnerabilityFeeling abandoned/rejectedOverprotectiveness
Table 1.Percentage of Persons Experiencing DisastersWho Are Diagnosed With PTSD
Bombing34Mass shooting33Plane crash29Violent assault19Motor vehicle accident14Assault, burn, industrial accident13Natural disaster4-5
:Modified from the
Disaster Mental Health Response Handbook
and Young et al.

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