Anxiety after a natural disaster:what is normal?Lauren Edwards, MDClinical InstructorUNMC Department of Psychiatry

No disclosures

Anxiety is NORMAL after a traumatic event• Anxiety and fear

- About what the future holds

- About what you are able to handle

- About your ability to do what is required to move forward

• Shock and disbelief – you may have a hard time accepting the reality of what happened

• Disorientation, trouble making decisions or concentration

• Nightmares and recurring thoughts about the event

• Change in life patterns that can lead to disruption and/or uncertainty – work, eating, sleeping

• Helplessness – the sudden, unpredictable nature of natural disasters may leave you feeling vulnerable and helpless

Not to mention feelings of sadness, guilt, anger, apathy, emotional numbing

http://www.mentalhealthamerica.net/conditions/coping-stress-natural-disasters

Stress is mental AND physical

• Trouble sleeping

• Upset stomach or change in bowel movements

• Cold sweats

• Heart racing

• Feeling short of breath

• Shaky/tremulous

• Feeling a lump in your throat

• Fatigue

How to cope with stress after a traumatic event occurs:

#1: ACCEPT YOUR FEELINGS

• Acknowledge that it is normal to feel anxious after experiencing a

traumatic event

• Let yourself take advantage of supports offered to you

• Seek help

• Don’t be hard on yourself for being human

• Accepting how you feel, and then caring for yourself, will allow you to best

be able to move forward and to be helpful to your family and neighbors

• Talk about it

• Spend time with family and friends

• Take care of yourself

• Limit exposure to images of the disaster

• Find time for activities you enjoy

• Take one thing at a time (make lists and check things off)

• Do something positive

• Avoid drugs and excessive drinking

• Ask for help when you need it

How to cope with stress after a traumatic event occurs:

What is normal stress?• Role of anxiety and the

stress response?

• Threat response –

Survival benefitLeft: Nebraska National GuardBelow: Associated Press

Anxiety or stress DISORDERS have at least one of the following characteristics:

• TOO MUCH anxiety – more than the situation requires

• GETS IN THE WAY of things, rather than helpful or manageable

• Occurs when there is no real threat

PTSD = Post-traumatic stress disorder

16.212.659.061.1Sudden death of a loved one

3.21.461.863.1Learned about a trauma

2.89.118.640.1Witnessed injury or death

-38.806.4Combat

5.43.715.218.9Natural disaster

1.86.313.825.0Accident

21.31.86.911.1Physical assault

26.512.212.32.8Molestation45.965.09.20.7Rape

WMWM

Rate of PTSD

Prevalence of EventTraumatic Event

Breslau N et al: Psychol Med. 1999 Jul;29(4):813-21.

Monitor for PTSD

Who is at risk for developing PTSD?

• Specific populations: minorities, elderly, children, direct victims, first responders

• Persons who bear the brunt of the social and/or economic consequences of the disaster

• Loss of a loved one or property

• Ongoing consequences like black out or water contamination

• Magnitude of exposure to the event

• History of prior traumas

• Low social support and/or poor relationships

• Preceding issues with mood and/or anxiety

Feeling like you are re-experiencing the trauma through intrusive, distressing recollections of the event, flashbacks or nightmares

Signs concerning for PTSD

Emotional numbness and avoidance of places, people and activities that remind you of the trauma

Signs concerning for PTSD

Feeling on edge which can lead to difficulty sleeping and concentration, feeling jumpy, and being easily irritated and angry

Signs concerning for PTSD

Screen yourself or a family member for PTSD and then discuss with your health care provider: https://adaa.org/screening-posttraumatic-stress-disorder-ptsd

Monitor for any ongoing difficulty with functioning15% of people who had experienced a natural disaster had diagnosed depression or anxiety disorders, and 50% had subclinical symptoms (meaning ongoing issues that they have just learned to live with) Wang et. al. (2013)

“Katrina brain” – sub-threshold PTSD was so common in Louisiana after Hurricane Katrina that this syndrome of irritability, diffuse anger, guilt, and health worries developed its own name

Increased risk of suicide in 9/11 survivors Marshall et. al. (2001)

• If symptoms of anxiety or mood are interfering with your ability to function and go about your day-to-day life

• If you find yourself turning to drugs and alcohol to cope with symptoms

• If you feel like your physical health has declined after a trauma, consider the toll untreated stress may be taking on your body

When in doubt, take yourself or your family to your doctor for screening

When to seek help

Primary care providers:Recommend increased screening for mood and anxiety disorders over the next 6-12 months

Consider a community-based campaign to increase “post-disaster mental health screenings to assess prior traumatic stress and specific information about the impact of the disaster for each family,” either by reaching out to patients or coordinating with schools or other local partners

EARLY ACCESS TO TREATMENT IMPROVES RECOVERY

Adams et. al. 2015

What to do if anxiety continues:

• Go to see your primary care physician

• Find a local counselor or psychiatrist

• Talk to your family about what you’re experiencing

• Keep engaging in life and in the memories – avoiding them makes symptoms worse over time

• Get support!

References1. Adams, Z.W., Danielson, C.K., Sumner, J.A., McCauley, J.L., Cohen, J.R., & Ruggiero, K.J. (2015). Comorbidity of ptsd,

major depression, and substance use disorder among adolescent victims of the spring 2011 tornadoes in alabama and joplin, missouri. Psychiatry, 78,170-185.

2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association.

3. Anxiety and Depression Association of America. Screening for Posttraumatic Stress Disorder: https://adaa.org/screening-posttraumatic-stress-disorder-ptsd. Date accessed 3/29/2019.

4. Marshall RD, Olfson M, Hellman F, et al. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry. 2001;158:1467-1473.

5. Mental Health America: Coping with the Stress of Natural Disasters. http://www.mentalhealthamerica.net/conditions/coping-stress-natural-disasters. Date accessed 3/28/2019.

6. Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38:467-480.

7. Wang, C., Chan, C.L., & Ho, R.T.H. (2013). Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: A systematic review of epidemiological studies across 1987-2011. Social Psychiatry and Psychiatric Epidemiology, 48, 1697-1720.

Questions?Contact Lauren Edwards, MD, at University of Nebraska Medical Center’s

Anxiety Subspecialty Treatment Clinic

For a patient consultation, call 402-552-6007

Clinic Practice Location:

Poynter Hall, 42nd and Dewey St.

985575 Nebraska Medical Center Omaha, NE 68198-5575

E-mail:

Lauren.Edwards@unmc.edu