Understanding the Difference Between Emotional Responses to Tragedy and the Development of Psychiatric Disorders

UNH students, faculty and staff have experienced many different thoughts and emotions related to the terrorist attacks on September 11 and the continued threat of bio-terrorist activity. It is important for us to understand the difference between normal emotional responses to the tragedy and symptoms that develop over time that might require professional mental health intervention. The chart below is provided to help our community recognize these differences.

Faculty and staff can receive mental health support services through the University's Employee Assistance Program by calling 1-800-424-1749. UNH students can receive the same service by calling the Counseling Center at 603-862-2090.

Response or Disorder	Definition	Duration	Symptoms	Treatment
Grief (Emotional response)	NOT a psychiatric disorder A common, intense and painful reaction to loss, death of a loved one, family member or friend	Symptoms generally occur immediately, 1 month after, and up to 1 year from the time of loss	Numbness, Loneliness, Sadness, Guilt, Shock, Anxiety, Anger, Agitation, Crying, Insomnia, Restlessness, Withdrawal	Talk about/share feelings Tolerate emotions Allow time to pass Occasionally, seek counseling Symptomatic, or brief course of, medication
Depression (Psychiatric Disorder)	A psychiatric disorder At least 2 weeks of depressed mood and/or loss of interest in regular, daily activities	Symptoms occur consecutively for a least 2 weeks, uninterrupted Diagnosis may be delayed for 2 months after traumatic event to distinguish from grief.	Depressed mood, Loss of pleasure or interest in ordinary activities, Feelings of guilt, worthlessness or hopelessness, Loss of energy or fatigue, Difficulty in concentrating or making decisions, Restlessness or irritability, Changes in sleep patterns, Changes in appetite or weight, Thoughts of death or suicide	Medication Psychotherapy (talk therapy) Group therapy Support groups Crisis intervention Hospitalization
Stress Reaction (Emotional Response)	NOT a psychiatric disorder A "normal" reaction to a disaster, trauma or highly stressful life event	Symptoms occur immediately after and may continue for a period of time after event	Disbelief and shock, Irritability and anger, Sadness, Feeling powerless, Feeling indecisive, Crying, Headaches or stomach problems, Difficulty sleeping	Alleviate emotional distress Promote problem-solving techniques When comfortable, getting back into "usual routine" Seek counseling, if necessary
Adjustment Disorder (Psychiatric disorder)	A psychiatric disorder Development of clinically significant emotional or behavioral symptoms and marked distress or significant impairment Occurs in response to an identifiable psychosocial stressor or stressors	Symptoms develop within 3 months after the onset of the stressor(s) Symptoms usually resolve within 6 months of termination of stressor(s) event Not applicable when symptoms represent grief	Depressed mood, Changes in sleeping or eating patterns, Social withdrawal, Mild suicidality, Fear/anxiety about future, Apathy and emotional numbing, Low self-esteem, Anxiety, Increased motor activity, Potential excess use of alcohol or drugs Severity of symptoms and degree of impairment are not as great as in depression and PTSD.	Short-term psychotherapy Crisis intervention Judicious use of medication Group therapy
PTSD (Post Traumatic Stress Disorder - psychiatric disorder)	A psychiatric disorder Follows experiencing or witnessing events involving actual or threatened death, and/or physical injury Person's response involves intense fear, helplessness and horror Persons with prior psychiatric history may be at increased risk for PTSD.	Symptoms must be present for more than 1 month Symptoms may be delayed for years after event May or may not be preceeded by diagnosis of Acute Stress Disorder	Intrusive Responses: Nightmares, sudden and frightening memories, feeling like the terrible event is happening again, distress at reminders Avoidance/numbing responses: Forgetting some or all of what happened, depressed mood, disconnected from others, loss of goals Increased arousal responses: Nervousness, racing heart, irritability/anger, insomnia, feeling edgy/easily startled, feeling distrustful or on guard, body aches or muscle tension, difficulty concentrating Associated features: Guilt, phobias, abuse, self-destructive behavior, shame, despair, feeling damaged, social withdrawal, impaired relationships, change in personality, abuse of alcohol or drugs Prior to one month, persons with above symptomatology may have Acute Stress Disorder (ASD) where dissociative symptoms are predominant. Approximately half of all persons with ASD go on to develop PTSD.	Medication, especially SSRI's Cognitive-behavior therapy Hospitalization, only if indicated

Contents adapted from materials prepared by Douglas Jacobs, MD and Amy Bloom, MPH and Sharon Pigeon, LICSW, MSW
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Understanding the Difference Between Emotional Responses to Tragedy and the Development of Psychiatric Disorders