The last few decades have seen a steady increase in disasters around the world. Whether caused by humans or nature, for many communities disasters occur with such frequency that they overlap each other. The traditional Phases of Disaster model–anticipation, impact, adaptation, and recovery (Raphael, 1986)–no longer make sense in all situations, as communities are often unable to reach the recovery phase of one disaster before they are anticipating or impacted by another disaster or major crisis.
The new model of disaster, the Chronic Cyclical Disaster Model, directly addresses the reality of overlapping disasters and also engages with how a community’s stress threshold affects their resilience in the face of those disasters. Developed by a group of psychiatrists, psychologists, and social workers, the model provides a new blueprint for communities, individuals, behavioral health and other disaster responders, to better understand the physio psychological impact after experiencing multiple or ongoing disasters.
Disasters also don’t happen in a vacuum. For every community that experiences a disaster, there are people whose experience will be complicated by everyday stressors they face. These stressors range from foundational issues like systemic racism and intergenerational trauma to chronic stressors like housing instability and community or interpersonal violence (Beckie, 2012; Chen et al., 2007; Guidi et al., 2021). Additionally, for the last few years every community around the globe has been coping with the overarching fear and grief related to the ongoing COVID-19 pandemic.
These stressors affect community resilience–people’s ability to “bounce back” to a pre-disaster state–in the face of a single disaster, let alone when multiple disasters strike at the same time. The theory behind this, known as allostatic load, gives us an understanding of the different resilience capabilities not only between communities but within communities. Simply put, the more stressors a group of people experience, the quicker they reach their stress threshold when hit with disaster(s), and the lower their resilience–their “bounce back” factor–becomes.
In many cases, these stress thresholds aren’t the same throughout a community. Sub-communities often have different experiences of the world due to uneven access to resources such as food, safe housing, and healthcare, along with different stressors from racism, sexism, ableism, ageism, homophobia, transphobia, xenophobia, and more (Chandra et al., 2021). These impact how the sub-community is able to respond to the disaster and can result in a portion of a community being unable to bounce back physically or psychologically.
Imagine living paycheck to paycheck while experiencing violence every time you try to use a public bathroom. That’s stressful enough. Imagine all that while also trying to recover from a hurricane that destroyed your home, only to have a mass shooting occur at the elementary school your child goes to, all during a global pandemic. It wouldn’t be easy for anyone to recover.
Post-traumatic stress disorder (PTSD) and its newer associate complex PTSD (cPTSD) are both caused by experiencing traumatic events and include symptoms such as re-experiencing the trauma (flashbacks and nightmares), avoidance of reminders, dissociation, and a constant vigilance for any threats. For cPTSD, one must also display symptoms of Disturbance in Self-Organization, which is noted by continuing interruptions to daily life due to ongoing traumatic events (Kairyte et al., 2022; Rossi et al., 2022).
The increase of chronic, compounding disasters around the world means that more people are being exposed to overlapping traumatic events and therefore more people are at risk of developing PTSD and cPTSD in the aftermath–especially those who are not provided the proper crisis supports, psychological first aid, and behavioral health resources that can help them work through their experiences (Alessi et al., 2021; Chen et al., 2007). For communities that experience systemic inequalities and uneven distribution of resources–things that worsen their community’s ability to bounce back–the risk for developing PTSD and cPTSD is even higher. For example, a look into the literature shows that 16-38% of refugees and asylum seekers exhibit cPTSD symptoms (de Silva, 2021; Maercker et al., 2022). In contrast, a German study of cPTSD among the general population showed a prevalence of just 1% (Maercker et al., 2022).
While thankfully most people who experience traumatic events will not develop PTSD or cPTSD, those who do develop one or the other can face stigma and negative assumptions within their community. Those who do not develop long-lasting mental health issues sometimes view those who have as being overly dramatic or needing to suck it up (Healthwise, 2022; Jacobs et al., 2019; Lowe et al., 2019; Revelant, 2018). People do not always understand how experiencing multiple disasters and crises increases the risk of developing PTSD or cPTSD. We do not always allow for how living through adverse social conditions such as systemic racism affects our ability to bounce back after a major disaster.
The best way to protect against PTSD developing is increased resilience. For an individual person, this means increased access to post-disaster supports including: Social services, housing, physical health, and mental well-being. Getting behavioral health professionals who specialize in disaster psychology on-site can be a major game changer for survivors. The practical application of Stress First Aid, Psychological First Aid, and Skills for Psychological Recovery can make all the difference for individuals and families in the direct aftermath.
For communities, increasing resilience looks different. A community’s resilience is directly tied to its broader social supports, community wealth, and experience of marginalization. Access to psychosocial support, health services, financial assistance, and childcare can do a lot to buffer a community’s allostatic load by addressing those foundational and chronic stressors. Further, educating community members on disaster planning and recovery allows communities to best figure out how to help themselves in times of crisis. This provides greater community self-reliance and allows the people to make the best decisions for themselves.
It is more important than ever that we, as a society, realize that the incidents of conditions like PTSD and cPTSD may increase due to multi and chronic-disasters, especially if there is a lack of disaster specific behavioral health response activities. PTSD and cPTSD are not diagnoses limited to people who have gone to war, nor are they conditions that a person can just “get over” without proper care and treatment. Like any mental health condition, PTSD and cPTSD change how our bodies react to and process the world around us, causing people to “overreact” to seemingly minor stressors or inconveniences.
A person with PTSD or cPTSD cannot help the ways in which they automatically react to triggers, but there are ways that they can manage their responses, especially with the help of their community and professional intervention. These conditions can be debilitating, isolating, and terrifying, causing people to relive the worst moments of their lives with the slightest reminder or other stressor. The National Center for PTSD is one of the leading arms for PTSD care and has recommendations for determining signs of good PTSD care along with helpful descriptions of the types of PTSD now available that can be effective and bring hope to those who experience this disorder (Signs of Good PTSD Care – PTSD: National Center for PTSD (va.gov)).
Understanding how we, in big and small ways, can help lower foundational and chronic stressors is critical. We need to anticipate and prepare for the likelihood that our communities will experience more than one disaster at a time. Each of us must know our role as survivors, community leaders, and/or first responders so that our work is effective in decreasing the negative mental health impacts of these events. We can start by recognizing that not all of us will have the same response to disasters and advocating so that everyone impacted has access to the support and resources needed to address the impact of disasters on our community members’ mental health.
April Naturale, PhD, is the Assistant Vice President, National Programs and Lindsay Mixer, MA, ABD, is the Operations Coordinator, Crisis Emotional Care Team (CECT) at Vibrant Emotional Health.
References
Alessi, E. J., Hutchison, C., & Kahn, S. (2022). Understanding covid-19 through a complex trauma lens: Implications for effective psychosocial responses. Social Work, 67(1), 79-87.
Beckie, T. M. (2012). A systematic review of allostatic load, health, and health disparities. Biological Research for Nursing, 14(4), 311-346.
Casas, J. B., & Benuto, L. T. (2022). Breaking the silence: A qualitative analysis of trauma narratives submitted online by first responders. Psychological Trauma: Theory, Research, Practice, and Policy, 14(2), 190.
Chandra, A., Acosta, J., Howard, S., Uscher-Pines, L., Williams, M., Yeung, D., … & Meredith, L. S. (2011). Building community resilience to disasters: A way forward to enhance national health security. RAND Health Quarterly, 1(1).
Chen A.C.-C., Keith V.M., Leong K.J., Airriess C., LI W., Chung K.-Y., & Lee C.-C. (2007) Hurricane Katrina: prior trauma, poverty and health among Vietnamese-American survivors. International Nursing Review, 54, 324–331
de Silva, U., Glover, N., & Katona, C. (2021). Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review. BJPsych Open, 7(6), e194.
Guidi, J., Lucente, M., Sonino, N., & Fava, G. A. (2021). Allostatic load and its impact on health: a systematic review. Psychotherapy and Psychosomatics, 90(1), 11-27.
Healthwise Staff. (2022, February 9). PTSD Myths. MyHealth Alberta. https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=ug4379&
Kairyte, A., Kvedaraite, M., Kazlauskas, E., & Gelezelyte, O. (2022). Exploring the links between various traumatic experiences and ICD-11 PTSD and Complex PTSD: A cross-sectional study. Frontiers in Psychology, 13:896981. doi: 10.3389/fpsyg.2022.896981
Krzemieniecki, A., & Gabriel, K. I. (2021). Stigmatization of posttraumatic stress disorder is altered by PTSD Knowledge and the precipitating trauma of the sufferer. Journal of Mental Health, 30(4), 447-453.
Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60-72.
Raphael, B. (1986). When disaster strikes: How individuals and communities cope with catastrophe. Basic Books.
Revelant, J. (2018, April 17). Understanding the stigma around PTSD and how to overcome barriers to care. Everyday Health. https://www.everydayhealth.com/ptsd/ptsd-stigma/
Roscoe, R. A. (2021). The battle against mental health stigma: Examining how veterans with PTSD communicatively manage stigma. Health Communication, 36(11), 1378-1387.
Rossi, R., Socci, V., Pacitti, F., Carmassi, C., Rossi, A., Di Lorenzo, G., & Hyland, P. (2022). The Italian version of the International Trauma Questionnaire: Symptom and network structure of post-traumatic stress disorder and complex post-traumatic stress disorder in a sample of late adolescents exposed to a natural disaster. Frontiers in Psychiatry, 13, 859877. https://doi.org/10.3389/fpsyt.2022.859877
