11/05/2012 06:49 pm ET Updated Jan 23, 2014

Acute Stress and PTSD: Sandy's Longest-Lasting Devastation

Natural Disasters and Emotional Trauma

News reports covering the havoc Hurricane Sandy recently wrought across much of the East Coast have focused primarily on the physical devastation -- homes, businesses, beaches, and even entire towns washed away in an instant by the relentless wall of water. This is to be expected; after all, the easiest way to show the full magnitude of Sandy's power is through photos and videos of the chaos left in her wake. Obviously, it will take months, perhaps even years to repair and/or replace much of the destruction. For many of the storm's victims, "home" will never again be the same. That said, the longest-lasting, most detrimental effects of Sandy's wrath are likely to be emotional rather than physical.

Natural disasters such as this inevitably create psychological trauma. Initially, this manifests for most people as acute grief. Individuals see what they have lost and naturally experience tremendous sadness. Usually, the deepest pain comes not from the loss of large, societally revered items like cars, computers, and big-screen televisions, but from the loss of smaller items that can never be replaced -- a child's first artwork, family photos, a wedding dress, and similar mementos. Though people up and down the East Coast are currently experiencing this grief on a massive scale, it is not something we should necessarily pathologize. It is expected, it is usual, and for most people it is likely to run its course as time passes and lives are rebuilt.

Unfortunately, for some people -- particularly individuals with a history of anxiety, depression, or similar disorders -- the acute stress reaction brought on by a natural disaster such as Sandy does not abate so easily. Studies suggest that approximately 25 percent of those affected by high-impact disasters such as hurricanes are likely to meet the criteria for post-traumatic stress disorder (PTSD) six months after the event. And the symptoms may stick around for years if left undiagnosed and/or untreated.

Recognizing Acute Stress and PTSD

Different people react to natural disasters in vastly different ways. In other words, Sandy's impact will vary from person to person. However, as mentioned above, an acute stress reaction is expected for many people, particularly those already susceptible to psychological disorders and/or individuals traumatized by the storm through physical injury, losing a loved one, or witnessing someone's death.

Interestingly, PTSD can just as easily be triggered by the threat or fear of loss as by actual loss. In other words, with natural disasters and other traumatic events the psychological damage can be as bad or even worse for people who are not personally injured as it is for those who are. As an example, you might imagine the trauma experienced by a mother who is safe and dry in another state but cut off from her children in the danger zone. For days, thanks to power outages and downed communications networks, she has no idea where they are or if they're okay. The children, of course, know they're fine, and they also know their mother is fine because she's in another state, nowhere near the damage. The kids are able to grieve what they've lost and move forward with the moment-to-moment process of recovery, whereas mom can only stew in her teapot of terror. In this way, it is possible for the person who didn't experience the storm directly (mom) to suffer the more serious emotional trauma.

Signs and symptoms of trauma-related acute stress and PTSD include:

• Intense, unpredictable feelings, including irritability, mood swings, anxiety, and depression
• Repeated and vivid memories (flashbacks) of the event leading to physical reactions such as rapid heartbeat, sweating, etc.
• Mental confusion, difficulty making decisions
• Issues with sleeping or eating
• Constant or intermittent fear that the event will be repeated
• Diminished interpersonal skills -- becoming more withdrawn, avoidant, or prone to conflict
• Headaches, nausea, chest pain, and other stress-typical physical manifestations
• As mentioned earlier, individuals with a history of psychological issues are more likely than others to experience such symptoms.

Dealing with Sandy-Induced Stress and/or PTSD

There are a wide variety of actions people can take to help themselves, their loved ones, and their children deal with trauma brought on by a natural disaster. First and foremost is not going through the experience alone. In other words, share your concerns with other people who are also affected by the experience. In this way you can normalize whatever it is that you are feeling by learning that others are feeling exactly the same things. And remember, it's OK for you and the people around you to be sad about your losses. Grieving is perfectly natural after a disaster like Sandy.

You can also take steps that decrease your tendency to "catastrophize." Giving free reign to those "sky is falling" feelings -- a.k.a., "living in the wreckage of the future" -- only serves to intensify the current trauma. Instead of dwelling on what may happen (or re-happen) at some unknown future time, focus on the present by making a list of what you can realistically take care of right now. Breaking things down into manageable steps helps you focus on rebuilding rather than thinking the world is going to end. And each time you take "the next right step," you are able to cross that item off your list, which helps you to understand that you are indeed making concrete progress.

Young Children

Kids, especially the little ones, are pretty resilient. Don't assume that just because a child has been through a difficult experience that he or she is traumatized, but do keep an eye out for symptoms. If a child is showing excessive worry or fears, or having nightmares, talk to the child about it. Help the child to understand that he or she has been through a terrible event, but things are fine now and you're there to make sure they stay that way.

It also helps to create a safe space for young children, a place in which they feel secure. This can happen even if you're in a temporary shelter. If the child has a bed, help him or her to decorate the space in ways that make it more comfortable. And remember, young children like normalcy. Create as much of that as you possibly can. If schools are closed, do lessons with them anyway to maintain a semblance of routine.


Teens rely on electronic communication, even more so than in-person communication. If that is disrupted they may feel disconnected, which can increase their level of anxiety. And while parents have a great deal of sway in terms of reassuring younger children, teens are likely to resent such an effort. Even though they need and secretly desire that reassurance, they also view it as childish and they consequently work hard to reject it. As such, they often have a harder time than younger kids in a crisis. The best thing for teens is talking with other teens about what they are feeling. While support from a parent may feel toxic, that same care from a peer will be welcomed. If you're lucky, a teen support group will form spontaneously and organically. If not, as a parent you can try to subtly facilitate this process.

Another thing you can do for teens is give them assignments so they feel responsible for helping you (and themselves) get back on your (and their) feet. If you're in a shelter, they can help with sandbags, cooking, and organizing younger kids in game-playing and other activities. Asking teens to become part of the solution and trusting them with a degree of responsibility reinforces their role as junior adults. Furthermore, it gives them a sense of control, calms their anxiety, and helps them to feel more competent and adequate.

When Should People Be "Over It"?

A lot of times we have funny ideas about how quickly people should get better. And while most people are done with acute stress symptoms after six months, others are not. It is perfectly normal to still be quite bereaved at a year or more. The simple fact is the amount of time it takes to recover from stressful situations varies widely. And just because it takes one person longer than another doesn't mean we need to pathologize it.

Nevertheless, at some point we expect to see improvement -- usually around the six-month mark. Persistence beyond six months of symptoms -- such as severe anxiety, flashbacks, nightmares, exaggerated startle response, etc. -- is an indication that trauma is still fresh and manifesting in the individual both emotionally and physically. In such cases, treatments for PTSD may be in order. In particular, EMDR (eye movement desensitization and reprocessing) therapy can be helpful in decreasing symptoms.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. As CEO of Elements Behavioral Health he oversees a network of addiction treatment centers that include Promises, The Ranch, The Recovery Place, and Right Step.

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