Psychological and

psychopathological problems
of victims and rescuers
in accidents and catastrophes

An accident or a catastrophe can

touch:
Victims
Witnesses
Rescuers (doctors, life-guards, fire-fighters,
policeofficers, cityguards, soldiers, etc.)

Response to catastrophepsychological factors

Personality

Emotions
Motivation

Locus of Control
Sense of Coherence
Coping with Stress

PSYCHE PREDISPOSITIONS
If those above are strong or well organized they
CAN protect us by mitigating the adverse
effects of exposure to traumatic events (before
and after).
If they are weak or do not work properly they
CANNOT protect us and they can cause serious
mental disorders

Psychological Response to Trauma

Survivors Needs and Reactions
People often experience strong and
unpleasant emotional and physical responses
following exposure to traumatic events (e.g.
disasters).
These may include a combination of:
Fear & anxiety
Grief & loss
Shock
Hopelessness
Loss of Confidence
Mistrust

Sleep disturbances
Physical pain
Confusion
Shame
Shaken faith
Aggressiveness

Possible Physiological Symptoms

Loss of appetite
Headaches, chest pain
Diarrhea, stomach pain, nausea
Hyperactivity
Increase in alcohol or drug consumption
Nightmares
Inability to sleep
Fatigue, low energy

Possible Emotional/Psychological
Symptoms

Irritability, anger
Self-blame, blaming others
Isolation, withdrawal
Fear of recurrence
Feeling stunned, numb, or overwhelmed
Feeling helpless
Mood swings
Sadness, depression, grief
Denial
Concentration, memory problems, confusion
Relationship conflicts

Possible Psychological Reactions

to a Large-Scale Emergency
Many people survive disasters without
developing any significant psychological
symptoms.
For other individuals, the reactions will
disappear over time.
Just because you have experienced a
disaster does not mean you will be damaged
by it, but you will be changed by it.
(Weaver 1995)

John Gaspari, University of Southern California

Phases of Disaster
Honeymoon
(community cohesion)

llllllllllll
Reconstruction

Heroic
Pre-Disaster

(a new beginning)

Disillusionment

Threat
Warning

EVENT
Inventory
Trigger Events and
Anniversary Reactions

Time

1 to 3 days

1 to 3 years

Psychopathological reactions to
catastrophes

Refers to pathological (according to DSM-IV)

Anxiety Disorders
-Acute Stress Disorder
-Obsessive Compulsive Disorders
-Posttraumatic Stress Disorder
Substance-Related Disorders
-Alcohol Dependence

Psychopathological reactions to
catastrophes
Mood Disorders
-Depressive Disorder
Personality Disorders
-Borderline Personality Disorder

Psychopathological problems of Victims and Rescuers

Anxiety Disorders
Acute Stress Disorder
Diagnostic Criteria
The person has been exposed to a traumatic event in which both of the following
were present:
1.The person experienced, witnessed, or was confronted with an event or events that
involved actual or threatened death or serious injury, or a threat to the physical
integrity of self or others integrity of self or others
2.The person's response involved intense fear, helplessness, or horror
Either while experiencing or after experiencing the distressing event, the individual
has three (or more) of the following dissociative symptoms:
1.a subjective sense of numbing, detachment, or absence of emotional
responsiveness
2.a reduction in awareness of his or her surroundings (e.g., "being in a daze")
3.derealization
4.depersonalization
5.dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

Acute Stress Disorder

The traumatic event is persistently reexperienced in at least one
of the following ways:
recurrent images,
thoughts,
dreams,
illusions,
flashback episodes,
Marked avoidance of stimuli that arouse recollections of the
trauma (e.g., thoughts, feelings, conversations, activities, places,
people).
Marked symptoms of anxiety or increased arousal (e.g., difficulty
sleeping, irritability, poor concentration, hypervigilance, exaggerated
startle response, motor restlessness).
The disturbance lasts for a minimum of 2 days and a maximum
of 4 weeks and occurs within 4 weeks of the traumatic event.

Posttraumatic Stress Disorder

Diagnostic Criteria (DSM-IV)
A. The person has been exposed to a traumatic
event in which both of the following were
present:
1.the person experienced, witnessed, or was
confronted with an event or events that
involved actual or threatened death or serious
injury, or a threat to the physical integrity of
self or others
2.the person's response involved intense fear,
helplessness, or horror

Posttraumatic Stress Disorder

B. The traumatic event is persistently
reexperienced in one (or more) of the
following ways:
1.recurrent and intrusive distressing
recollections of the event, including images,
thoughts, or perceptions.
2.recurrent distressing dreams of the event.
3.acting or feeling as if the traumatic event were
recurring (includes a sense of reliving the
experience, illusions, hallucinations)

Posttraumatic Stress Disorder

C. Persistent avoidance of stimuli associated

with the trauma and numbing of general
responsiveness:
1.efforts to avoid thoughts, feelings, or
conversations associated with the trauma
2.efforts to avoid activities, places, or people
that arouse recollections of the trauma
3.inability to recall an important aspect of the
trauma
4.markedly diminished interest or participation
in significant activities

Posttraumatic Stress Disorder

D.Persistent symptoms of increased arousal as
indicated by two (or more) of the following:
1.difficulty falling or staying asleep
2.irritability or outbursts of anger
3.difficulty concentrating
4.hypervigilance
E. Duration of the disturbance (symptoms in
Criteria B, C, and D) is more than 1 month.

Posttraumatic Stress Disorder

F.Functional significance
The disturbance causes clinically significant
distress or impairment in social, occupational,
or other important areas of functioning

Whats new according to DSM-V?

- new chapter: Trauma- and Stressor-Related

Disorders (earlier: anxiety disorder)
- extended definitions of the trigger to PTSD
- DSM-V pays more attention to the behavioral
symptoms accompanying PTSD
- four distinct diagnostic clusters instead of three (reexperiencing, avoidance, negative cognition and
mood, arousal)
- no distinction between acute and chronic PTSD
- two new subtypes:PTSD in children under 6, PTSD
with prominent dissociative symptoms

Obsessive Compulsive Disorders

Overview

Obsessions as defined by:

1.recurrent and persistent thoughts, impulses, or images that are
experienced, at some time during the disturbance, as
intrusive and inappropriate and that cause marked anxiety or
distress
2.the thoughts, impulses, or images are not simply excessive
worries about real-life problems
3.the person attempts to ignore or suppress such thoughts,
impulses, or images, or to neutralize them with some other
thought or action
4.the person recognizes that the obsessional thoughts, impulses,
or images are a product of his or her own mind (not imposed
from without as in thought insertion)

Obsessive Compulsive Disorders

Compulsions as defined by:
1. repetitive behaviors,e.g.
- hand washing, - ordering, - checking
or mental acts, e.g. - praying, - counting, - repeating words
silently that the person feels driven to perform in response to
an obsession, or according to rules that must be applied
rigidly
2. the behaviors or mental acts are aimed at preventing or
reducing distress or preventing some dreaded event or
situation; however, these behaviors or mental acts either are
not connected in a realistic way with what they are designed
to neutralize or prevent or are clearly excessive

Alcohol dependence
Substance-Related Disorders -Alcohol Dependence
Diagnostic Criteria
Alcohol abuse: A destructive pattern of alcohol use, leading to significant
social, occupational, or medical impairment.
Must have three (or more) of the following, occurring when the alcohol use
was at its worst:
1.Alcohol tolerance: need for markedly increased amounts of alcohol to
achieve intoxication,
2.Alcohol withdrawal symptoms
(a) Two (or more) of the following, developing within several hours to a few
days of reduction in heavy or prolonged alcohol use:
sweating or rapid pulse, increased hand tremor, insomnia
vomiting,
physical agitation,
anxiety,
hallucinations or illusions
(b) Alcohol is taken to relieve or avoid withdrawal symptoms

Alcohol dependence
3.Alcohol was often taken in larger amounts or over a longer
period than was intended
4.Persistent desire or unsuccessful efforts to cut down or control
alcohol use
5.Great deal of time spent in using alcohol, or recovering from
hangovers
6.Important social, occupational, or recreational activities given
up or reduced because of alcohol use.
7.Continued alcohol use is continued despite knowledge of
having a persistent or recurrent physical or psychological
problem that is likely to have been worsened by alcohol (e.g.,
continued drinking despite knowing that an ulcer was made
worse by drinking alcohol)

Mood Disorders
Depressive Disorder
1.Abnormal depressed mood most of the day, nearly every day, for at least 2
weeks.
2. Abnormal loss of all interest and pleasure most of the day, nearly every day,
for at least 2 weeks.
1. Abnormal depressed mood
2. Abnormal loss of all interest and pleasure
3. Appetite or weight disturbance, either:
- Abnormal weight loss or decrease in appetite.
- Abnormal weight gain or increase in appetite.
4. Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
5. Activity disturbance, either abnormal agitation or abnormal slowing
6. Abnormal fatigue or loss of energy.
7. Abnormal self-reproach or inappropriate guilt.
8. Abnormal poor concentration or indecisiveness.
9. Abnormal morbid thoughts of death (not just fear of dying) or suicide.

Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, selfimage, and affects, and marked impulsivity beginning by early
adulthood and present in a variety of contexts, as indicated by five
(or more) of the following:
1.Frantic efforts to avoid real or imagined abandonment.
2.A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation
Identity disturbance: markedly and persistently unstable self-image
or sense of self
3.Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, sex, substance abuse, reckless driving, binge
eating).
4.Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior

Borderline Personality Disorder

5. affective instability due to a marked reactivity of
mood (e.g. irritability, or anxiety usually lasting a few
hours and only rarely more than a few days)
6. chronic feelings of emptiness
7. inappropriate, intense anger or difficulty controlling
anger (e.g., frequent displays of temper, constant
anger, recurrent physical fights)
8. transient, stress-related paranoid ideation or severe
dissociative symptoms

So it seems to be a good idea to examine the

Rescuers using psychological diagnostic
methods.
Instead of examining only their:
Theoretical Knowledge
or/and Practical Knowledge
or/and Physical Ability
or/and Health

 It is also important to examine Rescuers,

Victims and Witnesses using psychological
diagnostic methods after the traumatic
events
To get to know about their mental state.
To help them.

Rescuers
Kind
Flexible
Good Listening skills
Caring attitude
Approachable
Non-judgmental approach

Committed
Able to tolerate chaos
Patient
Trustworthy
Culturally aware
Empathetic

Guiding Principles in Providing

Psychological Support in Your Role
Protect from danger
Be direct and active
Provide accurate information about what
youre going to do
Reassure
Do not give false assurances
Recognize the importance of taking action
Provide and ensure emotional support

John Gaspari, University of Southern California

Do Say
Can you tell me what happened?
Im Sorry
This must be difficult for you
Im here to be with you

John Gaspari, University of Southern California

Avoid Saying . . .
I understand what its like for you.
Dont feel bad.
Youre strong/Youll get through this.
Dont cry.
Its Gods will.
It could be worse or At least you still have . . .

Goals of Psychological First Aid

Psychological first aid (PFA) promotes and
sustains an environment of:
SAFETY
CALM
CONNECTEDNESS
SELF-EFFICACY
HOPE

SAFETY: help people meet basic needs for food

and shelter, obtain medical attention;
CALM:listen to people who wish to share their
stories and emotions and remember that
there is no right or wrong way to feel
CONNECTEDNESS:help people contact friends
and loved ones
HELP:find out the types and locations of services
and direct people to them
SELF-EFFICACY: give practical suggestions that
steer people toward helping themselves.
John Gaspari, University of Southern California

Debriefing / Defusing:
technique used to assist responders in dealing with
the physical or psychological symptoms caused by
trauma exposure.
-helps to process the event and reflect on its impact.
-allows for the ventilation of emotions and thoughts
associated with the crisis event.
-provided as soon as possible but typically no longer
than the first 24 to 72 hours after the initial
impact of the critical event.

John Gaspari, University of Southern California

Efficient communication system

An alarm statement should:
- be brief
- not contain any professional vocabulary
- inform: -what happened, - who are
particularly vulnerable and need help - what
action to take in this situation

Posttraumatic growth
positive change experienced as a result of the
struggle with a major life crisis or a traumatic
event

opening up possibilities that were not present before.

a change in relationships with others
an increased sense of ones own strength if I lived through that, I can face anything.
a greater appreciation for life in general
the spiritual or religious domain. Some individuals experience a deepening of their
spiritual lives, however, this deepening can also involve a significant change in ones
belief system.
Just because individuals experience

growth does not mean that they

will not suffer. Distress is typical when we face traumatic events.

Self-Help Techniques
Know the normal reactions to stressful events
Be aware of your tension and consciously try to relax
Use the support system
Talk to someone you trust and with whom feel at
ease
Listen to what people close to you say and think
about the event

Self-Help Techniques (cont.)

Work on routine tasks if it is too difficult to
concentrate on demanding duties
If you cannot sleep or feel too anxious, discuss
this with someone you can trust
Express your feelings in ways other than
talking:
Draw
Paint
Play music
Journal

Self-Help Techniques (cont.)

Do not self-medicate
Go easy on yourself
Avoid inflated or
perfectionistic expectations
Seek professional advice if
reactions continue

Cognitive/Behavioral Approaches to
Stress Reduction
Adequate Rest
Exercise / Movement
Diet / Balanced Nutrition
Laughter / Tears
Time Away From Work Role