This revision, they note, was "partly in recognition of research demonstrating that traumatic events were in fact not uncommon. DSM-IV defines the traumatic stressor as when a person 'experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others" (Vasterling and Brewin 6).
The diagnostic criteria established by the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for PTSD state that an individual must have:
Witnessed, experienced, or otherwise been confronted with an event that involved actual or possible death, grave injury, or threat to physical integrity; and,
The individual's response to such a traumatic event must include severe helplessness, fear or horror (cited in Clancy 2004).
According to Clancy (2004), a number of professions such as law enforcement, firefighters and combat veterans tend to experience a higher incidence of PTSD than the population at large. In this regard, Clancy advises:
particular psychological term, Post-Traumatic Stress Disorder (PTSD), is used when specific clinical criteria concerning symptoms are met. PTSD may exist if symptoms persist for longer than one month and cause significant distress or impairment in social, occupational, or other important areas of functioning. The severity of symptoms for PTSD varies. It tends to wax and wane, but usually diminishes over time. More than half of PTSD cases resolve within three months. (30)
In fact, PTSD appears to be a more common reaction to natural disasters than previously believed, due in large part to the changing definitions and diagnostic criteria that have been applied to the disorder in recent decades. For example, researchers studied the impact of a natural disaster that occurred in 1972 in Buffalo Creek, West Virginia, when a dam collapsed and flooded the entire community with significant loss of life and property. Not surprisingly, almost everyone in the community suffered psychological consequences, with fully 90% of the survivors being symptomatic 2 years following the disaster and more than 33% continuing to suffer from disabling psychiatric symptoms even 5 years later (Myers and Wee). According to these authors, "Most of the symptoms fell into the categories of generalized anxiety disorder (GAD) and major depression disorder (MDD). Many years later, these data were reanalyzed for probable posttraumatic stress disorder (PTSD) which had not been a diagnosis at the time of the original study" (Myers and Wee 9). Subsequent analysis of the survivors identified a rate of PTSD at 2 years that was almost half (44%) among adults and almost a third (32%) among children, and the incidence of PTSD remained high 14 years after this natural disaster (Myers and Wee 9).
The findings are congruent with the results of a study by Vogel and Vernberg (1993) that found, "Conclusions concerning children's responses to disasters have shifted over time. Early studies, beginning in the 1950s, concluded that children's responses are relatively mild and transient. By the 1970s and 1980s, however, evidence emerged that for some children after some disasters, effects can be more severe and longer lasting" (465). The changing definitions of PTSD provided by the DSM have focused additional attention on children's reactions to natural disasters in recent years. As Vogel and Vernberg point out, "The latter findings became increasingly salient with the introduction of the diagnosis of posttraumatic stress disorder (PTSD) and a shift from reliance primarily on parental report to more direct examination of children" (465). The research to date suggests that children's reactions to natural disaster generally include: moderate levels of fear and anxiety, mild sleep disruption for a few months, some hypersensitivity, and temporarily heightened dependency on parents; however, these reactions are typically transient and milder than many observers might expect (Vogel and Vernberg). According to these authors, "The emphasis on short-term reactions was consistent with a U.S. government manual concerning the mental health needs of children who experience major disasters" (Vogel and Vernberg 465).
A survey of 1,000 adults conducted by Norris and Uhl (1993) following Hurricane Hugo determined that disaster-related acute stressors (including personal loss, financial loss, and especially injury and life threat) were predictive of elevations in seven domains of chronic stress (i.e., marital stress, parental stress, filial stress, financial stress, occupational stress, ecological stress, and physical stress); in addition, increased reports of symptoms of depression, anxiety, and somatization were identified and a number of adverse mental health effects from Hurricane Hugo were related to deterioration in perceived social support (Norris and Uhl).
More recently, Norris, Friedman, Watson, Byrne, Diaz and Kaniasty (2002) determined that when natural disasters resulted in severe destruction and disruption, such as in the case with the 1992 natural disaster that accompanied Hurricane Andrew, the resulting psychological effects were severe. According to Myers and Wee (2005), "As of 2001, Hurricane Andrew was the most thoroughly researched disaster in U.S. history. Thirty-three percent of Andrew's victims met the criteria for PTSD, and [presented with] several physiological measures indicative of lower immune functioning" (15). Likewise, Perilla, Norris, and Lavizzo (2002) studied residents of the region and determined that one quarter of the residents satisfied the criteria for PTSD, with symptom levels differing according to the severity of exposure. The majority of the studies of Hurricane Andrew to date have identified a high incidence of psychological disturbance, particularly in those neighborhoods that experienced the most losses and where the danger had been the most severe (Norris et al., 2002).
While the treatment of PTSD has become the sharp focus of an increasing number of studies in recent years due in large part to the alarming number of combat veterans returning from the Middle East who are suffering from this condition, the vast majority of these studies have been devoted to psychological responses to man-made disasters. For example, according to Person and Fuller (2007), this is especially true in cases of people who are already suffering from some type of mental disorder. In this regard, Person and Fuller emphasize that, "There is growing concern that the management of persons with psychiatric disabilities after disaster has been inadequate. Unfortunately, the literature is extremely limited, and empirical evidence on the best practices for addressing the needs of persons with psychiatric disabilities after disasters is sparse" (238).
Indeed, "sparse" is an understatement with a recent search of three popular databases conducted by Person and Fuller identified just 12 journal articles on this subject. These authors report that, "The 12 reviewed articles included persons with psychiatric disabilities after both natural disasters and acts of terrorism, both in close proximity to the disaster site and far away and in three different treatment modalities. All of the studies used clinically-based samples" (Person and Fuller 239). The findings of these studies suggest that the resiliency to natural disasters among this population mirrors that of the general population, but here again, more research is needed. In this regard, Person and Fuller add that, "The available literature indicated that many persons with psychiatric disabilities demonstrate an ability to handle the stress of a disaster without decompensation from their primary illness. However, the literature also revealed that persons with severe mental illness (SMI) can experience posttraumatic stress disorder (PTSD), depression, anxiety, and illness exacerbation after disaster" (239).
Other general findings that emerged from the review by Person and Fuller indicated that people who suffered from mental disorders who were already participating in some type of community-based treatment program evinced higher levels of resiliency to natural disasters than those who were not. According to Person and Fuller, "There is evidence that persons with SMI can be resilient in the short-term when they are enrolled in an assertive community treatment program prior to the disaster; however, the outcomes for people with severe mental illness in other treatment modalities are unclear" (239). Given the increasingly prevalence of PTSD in the United States, then, it is clear that additional research is needed in this area to help develop contingency plans for coping with the potential mass adverse reactions that could accompany a natural disaster among this segment of the population. As Person and Fuller emphasize, "Well-designed studies with clinical and population-based samples on disaster reactions of persons with psychiatric disabilities are needed for disaster psychiatrists and emergency planners to develop empirically-based treatment guidelines for this population" (Person and Fuller 240).
Other gaps in the literature included the need for more responsive approaches by employers for their workers who may experience natural disasters. A number of authors cite the apparent increasing prevalence of natural disasters in recent years and emphasize that the traumatic stress reactions to natural disasters requires a timely and meaningful response in the workplace. For instance, according to Clancy (2004), "Research has consistently demonstrated that debriefing is an important part of preventing and managing trauma-related stress. Because of concerns regarding stigma issues, debriefings should be…