Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, May 2, 1995 TAG: 9505020084
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: JANE BRODY
DATELINE: LENGTH: Long
Those who escaped harm and those who took part in rescue and recovery efforts may be as severely affected emotionally as the surviving victims and the families of the dead and injured.
Experts say witnesses to death and destruction are especially vulnerable to lasting emotional injury when children are harmed and the element of horror is pronounced.
The wound is called post-traumatic stress disorder, but long before 1980, when it first received official psychiatric recognition, it was known as battle fatigue, shell shock or war neurosis.
Pressure from veterans of the Vietnam War, in which as many as 800,000 service men and women were left with severe emotional scars, finally led the psychiatric profession to include the disorder in its official diagnostic manual.
In the years since, therapists have come to realize just how widespread and potentially crippling the disorder can be. It can affect not only those who narrowly escape death but also those who witness accidents, those who try to save victims and those whose family members or close friends are involved in fatal or potentially fatal episodes or who develop a life-threatening disease.
Dr. Richard D. Allen, director of the Counseling Center at the University of California at Santa Cruz, an editor of the ``Handbook of Post-Disaster Interventions,'' says the best way to protect against post-traumatic stress disorder is to set up professionally run debriefing sessions immediately after the incident to allow people to talk about their feelings and to understand that acute stress reactions like flashbacks, nightmares and suddenly being overwhelmed by feelings are ``normal reactions to an abnormal event.''
Without intervention, post-traumatic stress disorder can have devastating, long-lasting and even life-long consequences.
Among the common symptoms are nightmares and insomnia, anxiety or panic attacks, sudden vivid memories so strong that the person thinks the incident is happening again, outbursts of irritability or explosive anger and avoidance of any place or thing or person that is a reminder of the traumatic event. Other symptoms are persistent depression, self-medication with alcohol or drugs and guilt over having survived when others died.
Perhaps the most perplexing symptom to relatives and friends is emotional numbness: a withdrawal of affection and avoidance of close emotional ties with family members, friends and colleagues, the very people who can best help to ease the pain.
Other common aftermaths include being always on guard for danger and being very easily startled. Another common symptom is panic attack.
Symptoms of post-traumatic stress disorder can start weeks, months, even years after the upsetting event. Sometimes they emerge only after a second relatively innocuous incident that reminds the person of a more traumatic event. That is believed to be the case with some people who were physically or sexually abused as children. When symptoms of the disorder occur long after the traumatic event, people often fail to recognize the connection, which can seriously delay the diagnosis and result in futile doctor-hopping.
Many traumatic situations can set off the disorder. Among them are being raped or criminally assaulted, witnessing a murder or severe beating, being a victim of or witness to a vehicular or industrial accident, being a victim of child or spouse abuse, being a hostage or prisoner of war, having a child struck by an automobile or found to have cancer, or being involved in a natural disaster or one inflicted by humans, like the Oklahoma City bombing.
The disorder is more common than even most experts realize. For example, in a recent national survey of 4,008 women, Dr. Dean G. Kilpatrick of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston found that nearly one woman in five had been the victim of a completed rape or aggravated assault or both. Over all, nearly 13 percent of those surveyed had experienced post-traumatic stress disorder.
In another survey of 12,500 households, Dr. Kilpatrick reported that nearly 10 percent had lost a family member to homicide or drunken driving and that one in five family members had developed post-traumatic stress disorder as a result.
At a national conference held in April by the Anxiety Disorders Association of America, Dr. Terence M. Keane, a psychologist who is director of the National Center for Post-Traumatic Stress Disorder at the Veterans Administration Medical Center in Boston, reported that ``cognitive behavioral'' treatment, a kind of systematic desensitization, had been the most successful approach to date for this and other anxiety disorders.
Patients are taught deep relaxation techniques, and while they are in a relaxed state, they are gradually exposed to the circumstances that provoke their trauma-induced symptoms, at first through their imagination and eventually in the real world.
Talk therapy, an integral part of the treatment, helps patients understand and master their trauma reactions and to get on with their lives. In many cases, therapy in groups of people with the same or similar traumas can be very helpful. Dr. Sally Winston, a psychologist who is co-director of the Anxiety and Stress Disorders Institute of Maryland in Towson, cautioned relatives, friends and acquaintances against saying unhelpful things like ``it's God's will,'' ``bad things happen to good people'' and ``you should be over that by now.'' Untreated, post-traumatic stress syndrome often gets worse, not better.
Wednesday is National Anxiety Disorders Screening Day. Free screenings for the full spectrum of disorders are being offered by hospitals, clinics, institutes and psychotherapists throughout the country. For a nearby facility, call (800) 442-2020.
The American Psychiatric Association has published a pamphlet, "Post-Traumatic Stress Disorder," which can be obtained free by writing to the association, Dept. NYT, 1400 K Street N.W., Washington, D.C. 20005.
Another pamphlet, "Post-Traumatic Stress Disorder," is available for $2.50 from the Anxiety Disorders Association of America, 6000 Executive Boulevard, No. 513, Rockville, Md. 20852.
For those concerned about panic disorder, the National Institute of Mental Health offers free brochures and resource information to those who call (800) 64-PANIC (647-2642) or write to the institute, Panic Disorder Education Program, Parklawn Building, Room 799, 5600 Fishers Lane, Rockville, Md. 20857.
by CNB