Assume Resilience, Not Pathology, after Disaster

Article excerpt

RANCHO MIRAGE, CALIF. -- The first principle of psychiatric assistance for survivors of a disaster--and the principle most often overlooked--is that most people do not become psychiatrically ill afterward, Dr. Carol S. North said.

She and her research team have systematically interviewed more than 3,000 people who were directly involved in 15 kinds of disaster events, including natural disasters and intentional acts of terrorism such as bombings or bioterrorism. "People are really resilient," she said at the annual meeting of the American College of Psychiatrists. Most don't develop posttraumatic stress disorder (PTSD), and some people even grow stronger as a result of their experience.

"Don't pathologize, but when pathology occurs, be sure to recognize it and deal with it," including psychiatric problems that existed before the disaster and still affect patients--another overlooked aspect of "disaster psychiatry," said Dr. North, professor of crisis psychiatry at the University of Texas Southwestern, Dallas.

PTSD is the most common psychiatric diagnosis among disaster survivors, but it differs in some ways from nondisaster populations. "In the disaster field, we do not see delayed-onset PTSD," but it tends to be chronic in both disaster survivors and other populations, she said. Any time you see PTSD, approximately two-thirds of patients will have comorbidities that may be as important or more important to treat.

After a disaster, symptoms from the B and D criteria for PTSD diagnosis are common--symptoms of hyperarousal and intrusion. "Very commonly, I think they're the stuff of generalized distress after disasters," Dr. North said. These symptoms do not appear to be pathologic unless people also have the much less common C criteria--avoidance and numbing symptoms. …