Warning Signs and Risk Factors for Emotional Distress

It is common to feel stress symptoms before or after a crisis. Natural and human-caused disasters can have a devastating impact on people's lives, because they sometimes cause physical injury, damage to property, or the loss of a home or place of employment. Anyone who sees or experiences this can be affected in some way. Most stress symptoms are temporary and will resolve on their own in a fairly short time. However, for some people, particularly children and teens, these symptoms may last for weeks or even months and may influence their relationships with families and friends. Common warning signs of emotional distress include

• Eating or sleeping too much or too little
• Anger, feeling edgy, or lashing out at others
• Overwhelming sadness
• Pulling away from people and things
• Not connecting with others
• Having low or no energy
• Feeling like you have to keep busy
• Having unexplained aches and pains, such as constant stomachaches or headaches
• Feeling helpless or hopeless
• Excessive smoking, drinking, or using drugs, including prescription medications
• Worrying a lot of the time
• Feeling guilty but not sure why
• Thinking of hurting or killing yourself or someone else
• Having difficulty readjusting to home or work life

People at Risk of Emotional Distress

For those who have lived through a natural or human-caused disaster, the anniversary of the event may renew feelings of fear, anxiety, and sadness. Certain sounds, such as sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the disaster or cause them to fear that it's about to happen again.

Disasters have the potential to cause emotional distress. Some people are more at risk than others. This includes survivors living or working in the impacted areas (both youth and adults), first responders and recovery workers, and those at risk of intimate partner or family violence.

Warning Signs and Risk Factors for Youth

Children are often the most vulnerable of those impacted during and after a disaster. According to the National Child Traumatic Stress Network, a growing body of research has established that children as young as infancy may be affected by events that threaten their safety or the safety of their parents or caregivers: Link opens in a new windowhttps://www.nctsn.org/resources/early-childhood-trauma.

Disasters are unfamiliar events that are not easily understood by children, who can find them emotionally confusing and frightening. During the time of turmoil, they may be left with a person unfamiliar to them and provided with limited information. Some warning signs of distress in children ages six to 11 include

• Withdrawing from playgroups and friends
• Competing more for the attention of parents and teachers
• Being unwilling to leave home
• Being less interested in schoolwork
• Becoming aggressive
• Having added conflict with peers or parents
• Having difficulty concentrating

For teens, the impact of disasters varies depending on how much of a disruption the disaster causes their family or community. Teens ages 12 to 18 are likely to have physical complaints when under stress or be less interested in schoolwork, chores, or other responsibilities. Although some teens may compete vigorously for attention from parents and teachers after a disaster, they also may

• Become withdrawn
• Resist authority
• Become disruptive or aggressive at home or in the classroom
• Experiment with high-risk behaviors, such as underage drinking or prescription drug misuse and abuse

Children and teens most at risk for emotional distress include those who

• Survived a previous disaster
• Experienced temporary living arrangements, loss of personal property, and parental unemployment in a disaster
• Lost a loved one or friend involved in a disaster

Most young people simply need additional time to experience their world as a secure place again and receive some emotional support to recover from their distress. The reactions of children and teens to a disaster are strongly influenced by how parents, relatives, teachers, and caregivers respond to the event. They often turn to these individuals for comfort and help. Teachers and other mentors play an especially important role after a disaster or other crisis by reinforcing normal routines to the extent possible, especially if new routines have to be established.

Warning Signs and Risk Factors for Adults

Adults impacted by disaster are faced with the difficult challenge of balancing roles as first responders, survivors, and caregivers. They are often overwhelmed by the sheer magnitude of responsibility and immediate tasks of the crisis response and recovery at hand. They must also take the time to address their own physical and emotional needs as well as those of their family members and community.

Warnings signs of stress in adults may include

• Crying spells or bursts of anger
• Difficulty eating
• Losing interest in daily activities
• Increasing physical distress symptoms such as headaches or stomach pains
• Fatigue
• Feeling guilty, helpless, or hopeless
• Avoiding family and friends

Adults most at risk of experiencing severe emotional stress and posttraumatic stress disorder include those with a history of

• Exposure to other traumas, including severe accidents, abuse, assault, combat, or rescue work
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, or discrimination
• Recent or subsequent major life stressors or emotional strain, such as single parenting

Adults most at risk for emotional stress include

• Those who survived a previous disaster
• Those who lost a loved one or friend involved in a disaster
• Those who lack economic stability and/or knowledge of the English language
• Older adults who may lack mobility or independence

As with children and teens, adults also need time to get back into their normal routine. It is important that people try to accept whatever reactions they have related to the disaster. Take every day one at a time, and focus on taking care of your own disaster-related needs and those of your family.

Warning Signs and Risk Factors for First Responders and Recovery Workers

First responders and recovery workers include

• Firefighters; police officers; emergency medical technicians; 911 operators; and other fire, emergency, and medical personnel
• Military service men and women
• Clergy
• Staff and volunteers serving with disaster-relief organizations, including sheltering, animal rescue, food service, and crisis counseling

First responders and recovery workers are not only physically and emotionally tested during an emergency, but they also may have loved ones in the area for whom they are concerned. They also are often the last to seek help for work-related stress.

Warnings signs of stress in responders and recovery workers may include

• Experiencing a rapid heart rate, palpitations, muscle tensions, headaches, and tremors
• Feeling fear or terror in life-threatening situations or perceived danger, as well as anger and frustration
• Being disoriented or confused; having difficulty solving problems and making decisions
• Engaging in problematic or risky behaviors, such as taking unnecessary risks, failing to use personal protective equipment, or refusing to follow orders or leave the scene
• Becoming irritable or hostile in social situations, resorting to blaming, and failing to support teammates

First responders and recovery workers most at risk for emotional distress include those who have experienced

• Prolonged separation from loved ones
• Life-threatening situations
• Previous deployments that caused disruptions in home or work life
• Trauma from having witnessed or been exposed in some way to difficult stories of survival or loss

For first responders, being prepared for the job and strengthening stress-management skills before a disaster assignment is the best protection from stress. Responder stress can be diminished by practicing for the disaster role, developing a personal tool kit of stress-management skills, and preparing themselves and loved ones for a disaster.

Intimate Partner or Family Violence

Disasters can be extremely disruptive to individual families and community routines, leading to stress and inviting all types of violent behavior, including intimate partner violence or family violence. Women and girls can be particularly at risk. Following a disaster, resources for reporting violent crimes may be temporarily suspended or unavailable. For women and girls who have experienced intimate partner violence, sexual violence, or family violence, this can further heighten their sense of isolation and vulnerability.

Before, during, and after a disaster, what may seem like fighting between intimate partners or family members may actually be a symptom of a larger pattern of abuse. Further, during the response-and-recovery phase after a disaster, the risk for violence against women and girls becomes greater. These disaster survivors may become displaced from their homes and moved to shelters or temporary housing, where they encounter overcrowded, co-ed living conditions and a lack of security, among other things.

If you or someone you care about is or may be experiencing intimate partner, sexual, or family abuse or violence, contact your employee assistance program (EAP). This is a free, independent service, available 24/7.

Other resources are also available:

• Disaster Distress Helpline on 800-985-5990, or text "TalkWithUs" to 66746, Link opens in a new windowhttps://www.samhsa.gov/find-help/disaster-distress-helpline
• National Child Abuse Hotline on 800-4-A-CHILD (800-422-4453), Link opens in a new windowhttps://www.childhelp.org/hotline
• National Domestic Violence Hotline on 800-799-SAFE (800-799-7233) or TTY 800-787-3224, Link opens in a new windowhttps://www.thehotline.org
• National Sexual Assault Hotline on 800-656-HOPE (800-656-4673), Link opens in a new windowhttps://www.rainn.org/about-national-sexual-assault-telephone-hotline
• National Teen Dating Violence Hotline on 866-331-9474, or text "loveis" to 77054, Link opens in a new windowhttps://www.loveisrespect.org
• National Center on Elder Abuse, Link opens in a new windowhttps://ncea.acl.gov