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12 During an actual traumatic event, this response is consid- is the use of alcohol or drugs in attempts to cope with the trau- ered a normal, adaptive survival response to a situation that matic memories and intrusive thoughts associated with the is perceived as life threatening. If an individual is able to estab- trauma (Ford, Hawke, Alessi, Ledgerwood & Petry, 2007). lish safety by fighting or fleeing, it will often decrease, although Other work has documented that one of the most enduring not eliminate, the risk for long-term negative effects of the effects of traumatic stress involves increases in physical com- stressful event. However, traumatic events may not accommo- plaints that are not usually limited to any specific organ system date these survival responses, and individuals must attempt and are often medically unexplained (e.g., fatigue, headache). to cope with a situation that is perceived as life-threatening, Further outcome studies suggest that a number of trauma uncontrollable, and/or inescapable--a situation that carries survivors experience an overall decreased quality of life, more a higher risk for longer-term problems. absenteeism from work, and impaired social relationships. Life-threatening, inescapable situations can result in a different physical and psychological response--freezing or Post-Traumatic Stress and Human becoming immobilized. Although this response is less well Reactions to Trauma understood from a physiological standpoint, it appears that the stress response activates a different part of the ANS that Although a wide variety of psychopathology can result from immobilizes the body and decreases the experience of pain or exposure to trauma, when an individual continues to experi- fear (e.g., people going limp and psychologically numb when ence a persistent traumatic stress reaction after the traumatic being mauled by a bear). event has past, or post-trauma, it is called post-traumatic stress Psychological "numbness" is another way of describing (American Psychiatric Association, 2000). Thus, a stress re- what is more generally called dissociation--separating oneself sponse that was adaptive and normal during a time of crisis psychologically from an unbearable situation. It fragments becomes maladaptive when it persists after the traumatic event the personality in an attempt to minimize pain, and in this has passed. Post-traumatic stress is a human survival reaction way could be considered an adaptive reaction, but can inter- or elements of this reaction that occur when there is no actual fere with recovery to the extent that a person is then unable to threat present--a survival reaction that occurs at the wrong integrate the complete experience of the trauma (Noy, 2004). time. When post-traumatic stress is severe and persistent it Dissociation can occur at many different levels of severity is called Post-Traumatic Stress Disorder (PTSD) as described with the most severe involving a complete "splitting off" from in the Diagnostic and Statistical Manual of Mental Disorders: oneself--what was previously referred to as a multiple person- Text Revision (DSM-TR)--the standard reference used for ality and currently referred to diagnostically as Dissociative classifying and diagnosing psychiatric disorders (American Identity Disorder (American Psychiatric Association, 2000). Psychiatric Association, 2000). According to the DSM-TR (American Psychiatric Asso- ciation, 2000) diagnostic criteria, to qualify for a diagnosis Psychological Reactions of PTSD, one must have: (1) experienced an event that is life to Traumatic Events threatening or perceived as life threatening, (2) witnessed an A range of post-traumatic stress reactions can occur for event that is perceived as life threatening to others, or (3) heard individuals who experience or are exposed to trauma. For about violence to or the unexpected or violent death of others. example North, Nixon, Shariat et al. (1999) examined the The latter can involve such things as watching a traumatic impact of trauma exposure on the frequency and types of event unfold on television (e.g., Hurricane Katrina or the post-disaster psychopathology that developed. Nearly half events of 9/11) or hearing about the death of a loved one-- of the sample of 182 participants met criteria for one or more referred to as vicarious or secondary traumatization (Palm, psychiatric diagnosis after the disaster. The types of psychi- Polusny & Follette, 2004). atric diagnoses included Major Depression, Panic Disorder, Further, one must exhibit persistent evidence (i.e., lasting Generalized Anxiety Disorder, Alcohol Use Disorder, Drug more than one month) of (1) persistent re-experiencing of the Use Disorder and PTSD. traumatic event (e.g., intrusive memories or thoughts, flash- Subsequent investigators have also documented the impact backs, nightmares); (2) avoidance of reminders or the trauma of trauma exposure on the development of psychopathology. that can involve physical avoidance or psychological "avoid- Depression and anxiety are often observed in the aftermath ance" or numbness in the form of dissociation; and (3) chronic of trauma (Norris, Friedman, Watson, Byrne, Diaz & Kaniasty, hyperarousal of the autonomic nervous system (e.g., difficulties 2002; Noy, 2004; Rubonis & Bickman, 1991) along with a spec- sleeping, problems concentrating, hypervigilance, increased trum of grief reactions (Bonanno & Kaltman, 2001). Further, anxiety, exaggerated startle response). post traumatic stress reactions and depression co-occur quite One must also exhibit severe impairments in daily func- often following disaster. Another human reaction to trauma tioning (e.g., impaired relationships, employment problems)