PTSD: Why Traumatic Memories Are Often Repressed - Psychiatry

Dr. Wu Enliang reply Psychiatry

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The September 21 earthquake caused severe disasters across Taiwan, resulting in numerous casualties and the destruction of many homes.
Survivors faced the devastation of their communities, the loss of loved ones, and various difficulties in daily life, housing, and transportation, leading to immediate and ongoing negative impacts on their mental and physical well-being.
The shadow of aftershocks further exacerbated the situation.
As the frontline rescue efforts gradually came to a close, it became crucial to focus on post-disaster psychological rehabilitation and the treatment of related mental health disorders to prevent a secondary crisis (mental illness).
While homes can be rebuilt, the damage to the psyche can leave lasting scars.
Survivors are not merely a distinction between the living and the deceased; they often find themselves repeatedly recalling the events of the earthquake, trapped in traumatic experiences, grappling with feelings of guilt, psychological numbness, fatigue, avoidance of external support, and questioning the value and meaning of life.
These are potential psychological responses, but individual differences should also be acknowledged.
Common psychological symptoms following a disaster may include irritability, self-blame, blaming others, isolation, withdrawal, fear, shock, numbness, daze, feelings of helplessness, emotional instability, sadness, denial, difficulty concentrating, and memory impairment.
Physical symptoms may manifest as decreased appetite, dizziness, headaches, a sensation of choking in the throat, chest discomfort, gastrointestinal issues, diarrhea, fatigue, musculoskeletal pain, changes in activity levels, insomnia, and nightmares.
When significant traumatic events lead to persistent feelings of fear, helplessness, confusion, or agitation within four weeks, accompanied by numbness, detachment, loss of self-identity, difficulty recalling certain events, and dizziness, along with re-experiencing the trauma through dreams or memories, avoidance of trauma-related stimuli, and heightened alertness (such as irritability, hypervigilance, and startle responses), these symptoms may indicate acute stress disorder if they last from two days to four weeks.
If symptoms persist for more than one month, it may develop into post-traumatic stress disorder (PTSD), which can be classified as acute or chronic based on the duration (three months or less, or more than three months).
PTSD often coexists with other mental health disorders, such as depression, panic disorder, phobias, anxiety disorders, obsessive-compulsive disorder, mood disorders, and substance abuse or dependence.
Research following past earthquakes has shown that the prevalence of post-traumatic stress disorder is between 32% to 60% in adults and 26% to 95% in children.
Other potential psychological issues and mental disorders include grief reactions, sleep disorders, adjustment disorders, dissociative disorders, conversion disorders (hysteria), and reactive psychosis.
Individuals with pre-existing mental health conditions may experience a significant worsening of symptoms.
The psychological changes and mental health issues in disaster responders, children, and adolescents require immediate and proactive intervention to prevent the spread of severe psychological distress.
Therefore, there is an urgent need for prevention, early assessment, and diagnosis.
Effective coping strategies for individuals include not suppressing feelings, appropriately expressing emotions; not forcing oneself to forget; engaging in discussions about the disaster with others to allow for understanding and expressions of care; seeking opportunities to talk with family and children; striving to restore normal routines; ensuring adequate rest, sleep, nutrition, and exercise; and being particularly cautious about potential accidents post-disaster.
It is important not to hesitate to seek help from others and to consult professionals immediately when experiencing physical or mental health issues.
Children often become anxious, withdrawn, expressionless, sensitive, exhibit regressive behaviors, have sleep disturbances, feel guilt, and may present physical symptoms after an earthquake.
They particularly need adult support, and caregivers should provide them with a sense of safety through comforting words and physical contact to alleviate feelings of fear and loneliness.
Encouraging children to express their fears, pain, and grief through play, drawing, language, writing, and music is essential, as is showing concern and spending time with them in play with other children.
Older children should be encouraged to participate in community rebuilding efforts to foster a sense of family unity.
If mental health disorders unfortunately arise, prompt medical attention should be sought, and treatment should include medication and various psychosocial interventions (such as mental health education, relaxation training, breathing exercises, individual therapy, group therapy, cognitive therapy, and behavioral therapy).

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Reply Date: 2017/12/15