When a disaster strikes, the emotional and psychological toll can be immense. For crisis counselors working with survivors, it’s vital to recognize the difference between typical stress responses and more severe reactions that may point to a developing or pre-existing psychiatric disorder.
🚨 The Crisis Counselor’s Role: Recognize and Refer
In the Crisis Counseling Assistance and Training Program (CCP), crisis counselors do not provide treatment. Their core mission is to recognize severe reactions and potential psychiatric disorders and promptly alert their team leader or program manager.
Left unaddressed, severe reactions like social isolation, paranoia, and suicidal behavior can worsen, significantly interfering with daily life and potentially developing into a diagnosable psychiatric disorder.
The role of the team leader or mental health professional is to recognize and refer individuals needing treatment to local behavioral health services—not to provide treatment themselves. Counselors, with team consultation, may follow up to ensure survivors connect with the needed resources.
Important Note: Only a trained mental health professional can diagnose mental illness and provide psychotherapy. A psychiatrist or medical doctor typically prescribes medication.
🔎 Severe Reactions Requiring Immediate Attention
Severe reactions often result from the disaster’s trauma and may interfere with a survivor’s ability to cope.
Social Isolation
This involves a feeling of loneliness that the individual may experience as a threatening state imposed by others, or simply a deep sense of loneliness caused by the absence of support.
- Symptoms include: Feelings of loneliness or rejection imposed by others, a sense of being different, insecurity in public, a sad or dull affect, withdrawn behavior, lack of eye contact, preoccupation with own thoughts, and sometimes hostility.
- Be aware of: The possibility of social isolation is higher when counseling individuals known to have developmental disabilities, cognitive impairments, dementia, or traumatic brain injury.
Paranoia
Paranoia is an unfounded or exaggerated distrust of others, sometimes reaching delusional levels. The individual constantly suspects the motives of those around them, believing others are “out to get them.” Acute (short-term) paranoia may occur in some individuals overwhelmed by stress.
- Symptoms include: Believing others are plotting against them, unfounded doubts about friends, reluctance to confide, reading negative meanings into innocuous remarks, bearing grudges, perceiving attacks on reputation, and unfounded suspicions about a partner’s fidelity.
Suicidal Behavior
This is a severe reaction that may stem from several psychiatric disorders. Most people who die by suicide have a diagnosable and treatable psychiatric illness.
- Symptoms include: A history of attempted suicide (a major risk factor), a family history of suicide or psychiatric illness, unrelenting low mood/hopelessness, sleep problems, increased substance use, recent impulsive or risky behavior, threats of suicide or expressing a wish to die, making plans for self-harm, allocating prized possessions, sudden purchase of a firearm, acquiring other means (poisons, meds), or unexpected rage/anger.
🧠 Psychiatric Disorders Associated with Trauma
If severe reactions are left untreated or don’t respond to crisis counseling, they may develop into one of the psychiatric disorders often linked to traumatic events.
| Disorder | Description | Key Symptoms |
| Depressive Disorders | Illnesses affecting body, mood, and thoughts. Not a passing “blue mood” or a sign of weakness. Symptoms can last weeks, months, or years without treatment. | Persistently sad/irritable mood, changes in sleep/appetite/energy, difficulty thinking/concentrating, physical slowing or agitation, lack of interest/pleasure, feelings of guilt/worthlessness, thoughts of death/suicide, persistent physical symptoms (headaches, chronic pain). |
| Substance Abuse | A pattern of substance use leading to consequences in major life areas. Misuse is using a substance for reasons or ways other than intended. | Recurrent substance use causing failure to fulfill major role obligations (work, school, home), use in physically hazardous situations (driving), recurrent legal problems, continued use despite persistent social/interpersonal problems. |
| Acute Stress Disorder (ASD) | An anxiety disorder occurring within a month of a traumatic stressor, characterized by a cluster of dissociative and anxiety symptoms. | Being dazed or less aware of surroundings, depersonalization, dissociative amnesia, reexperiencing the trauma (dreams, flashbacks), avoidance of reminders, hyperarousal/anxiety (sleep problems, irritability, startle response, hypervigilance), impaired social function. |
| Anxiety Disorders | Unlike brief anxiety, these last at least 6 months and worsen if untreated. Often co-occur with other illnesses. Specific disorders include Panic Disorder, OCD, PTSD, and Generalized Anxiety Disorder. | Excessive, irrational fear and dread. Symptoms differ by specific disorder. Coexisting conditions (like alcoholism or depression) may need treatment first. |
| Posttraumatic Stress Disorder (PTSD) | An anxiety disorder developing after exposure to a terrifying event where grave physical harm occurred or was threatened. Symptoms must last more than a month. | Persistent frightening thoughts/memories of the ordeal, emotional numbness, sleep problems, feelings of detachment, being easily startled. |
| Dissociative Disorders | Characterized by a dissociation from a person’s fundamental aspects of waking consciousness (identity, history). Thought to stem from trauma. Includes dissociative amnesia, fugue, identity disorder, and depersonalization disorder. | The person literally dissociates themselves from a situation too traumatic to integrate with their conscious self. Symptoms are also seen in PTSD, Panic Disorder, and OCD. |
🛑 Recognizing Preexisting Psychiatric Disorders
Crisis counselors may also encounter survivors with preexisting psychiatric disorders who have become disconnected from treatment or are experiencing an aggravation of symptoms due to the disaster’s stress.
🌓 Bipolar Disorder (Manic Depression)
Causes extreme shifts in mood, energy, and functioning, often lifelong.
- Symptoms of Mania: Elated or irritable mood, increased physical/mental activity, racing thoughts, increased/rapid talking, ambitious/grandiose plans, risk-taking/impulsive activity (spending, substance abuse), decreased sleep without fatigue.
- Symptoms of Depression: Loss of energy, prolonged sadness, decreased activity, restlessness/irritability, inability to concentrate, increased worry/anxiety, lack of interest/enjoyment in activities, feelings of guilt/hopelessness, thoughts of suicide, changes in appetite/sleep.
🎭 Borderline Personality Disorder (BPD)
Characterized by instability in moods, interpersonal relationships, self-image, and behavior.
- Key Indicators (5 or more): Frantic efforts to avoid abandonment, unstable/intense relationships alternating between idealization and devaluation, unstable self-image, impulsivity in self-damaging areas (spending, sex, substance abuse), recurrent suicidal/self-mutilating behavior, affective instability (marked reactivity of mood), chronic feelings of emptiness, inappropriate/intense anger, and transient, stress-related paranoia or severe dissociative symptoms.
🍽️ Eating Disorders (Anorexia Nervosa and Bulimia Nervosa)
- Anorexia Nervosa: Refusal to maintain minimal body weight, intense fear of gaining weight, and distorted body image.
- Symptoms: Preoccupation with food, continuing to think of oneself as fat when thin, brittle hair/nails, dry/yellow skin, depression, hypothermia complaints, fine body hair (lanugo), strange eating habits.
- Bulimia Nervosa: Destructive pattern of binge eating and recurrent inappropriate behavior to control weight (e.g., self-induced vomiting).
- Symptoms: Constant concern about food/weight, self-induced vomiting, erosion of dental enamel, scarring on hands (from vomiting), swelling of cheek glands, irregular menstrual periods, depression, sore throats, abdominal pain.
🧼 Obsessive-Compulsive Disorder (OCD)
Characterized by obsessive thoughts (intrusive, irrational ideas) or compulsive behaviors (repetitive rituals) that consume over an hour a day and interfere with life.
- Symptoms: Repeatedly checking things, fear of harming others, feeling dirty/contaminated, constantly arranging/ordering, excessive concern with body imperfections, being ruled by numbers, excessive concern with sin/blasphemy.
🌪️ Panic Disorder
Recurrent panic attacks, at least one of which leads to a month of increased anxiety or avoidant behavior, or constant fear of having another attack.
- Panic Attack Symptoms (Typically lasting ~10 minutes): Sweating, hot/cold flashes, choking sensations, racing heart, labored breathing, trembling, chest pains, faintness, numbness, nausea, disorientation, feelings of dying, losing control, or losing one’s mind.
🧩 Schizophrenia
Interferes with a person’s ability to think clearly, distinguish reality from fantasy, manage emotions, and relate to others.
- Positive Symptoms (Psychotic): Delusions (believing others are plotting, reading thoughts) and Hallucinations (hearing or seeing things that aren’t there).
- Negative Symptoms (Lack of Normal Characteristics): Emotional flatness, inability to start/follow through with activities, brief/devoid speech, lack of pleasure/interest in life.
- Cognitive Symptoms (Thinking Processes): Difficulty prioritizing tasks, memory issues, disorganized thoughts, and often a lack of insight into the condition itself.
☁️ Schizoaffective Disorder
A combination of symptoms of schizophrenia and an affective (mood) disorder (major depression or manic episode).
- Key Difference: Delusions or hallucinations must be present for at least two weeks without prominent mood symptoms. The mood symptoms are more prominent and last longer than those in pure schizophrenia.
🤝 Co-occurring Mental Illness and Substance Abuse
Often called co-occurring disorders (or dual-diagnosis). Full recovery requires treatment for both problems simultaneously, focusing on one does not ensure the other will go away.
- Prevalence: Roughly 50% of individuals with severe mental disorders are affected by substance abuse. Similarly, a high percentage of alcohol/drug abusers also have at least one serious mental illness.
⚕️ Pathways to Treatment and Recovery
When a severe reaction or psychiatric disorder is suspected, the crisis counselor must alert the CCP team leader and clinical personnel. Referral to treatment is the necessary next step.
A comprehensive treatment approach often includes a combination of interventions:
- Support: Connecting with a peer counselor, support groups, family communication, and spirituality.
- Clinical: Establishing a personal connection with a health care provider, medication-assisted treatment (medication combined with counseling and behavioral therapies), and cognitive therapy.
- Wellness: Healthy living habits like exercise, balanced diet, moderate substance use, and stress reduction.
The 10 Fundamental Components of Mental Health Recovery
Recovery is a journey of healing and transformation, enabling a person to live a meaningful life. Key principles include:
- Self-Direction: The individual leads and controls their own path of recovery.
- Individualized and Person-Centered: Pathways are based on unique strengths, needs, and cultural background.
- Empowerment: Consumers participate in all decisions affecting their lives.
- Holistic: Recovery encompasses the whole life—mind, body, spirit, and community.
- Nonlinear: It is continual growth with occasional setbacks, not a step-by-step process.
- Strengths Based: Focuses on valuing and building on the individual’s inherent capacities and talents.
- Peer Support: Mutual support and sharing of experiential knowledge is invaluable.
- Respect: Community acceptance, protection of rights, and eliminating stigma are crucial.
- Responsibility: Consumers take personal responsibility for their self-care and journey.
- Hope: The essential, motivating message that a better future is possible and people can overcome obstacles.
➡️ Next Steps for Counselors
Suspecting a severe reaction or psychiatric disorder is a moment to alert your team leader and clinical personnel. Use resource linkage to refer the survivor to appropriate resources. Tools like the Adult Assessment and Referral Tool can help track survivors with severe reactions, always in consultation with CCP leadership.
Conclusion: Prioritizing Survivor Well-being
This information was designed to give crisis counselors greater insight into severe reactions to trauma and the psychiatric disorders they might encounter in a small number of disaster survivors.
When a severe reaction or psychiatric disorder is suspected, the immediate priority is to alert the CCP team leader and clinical personnel. The crisis counselor must then collaborate with the survivor to determine if a referral is needed and use resource linkage to connect them with the appropriate services.
Follow-up, when possible, helps ensure survivors have connected with the referred services. The Adult Assessment and Referral Tool can be used to track survivors who may be suffering from severe reactions, but this must always be done in consultation with CCP team leaders and clinical personnel.
🛑 Disclaimer
This blog post is intended for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
Clare Senior Care is an Adult Foster Care (AFC) and Group Adult Foster Care (GAFC) agency in Massachusetts, providing home health care services. This blog content is not part of any clinical treatment plan provided by Clare Senior Care. Always consult with your medical team regarding your specific health condition and care regimen.
📚 Sources
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC.
- Gale, T. (2007–2012). Encyclopedia of Mental Disorder. Acute stress disorder. Retrieved from http://www.minddisorders.com/A-Br/Acute-stress-disorder.html
- U.S. Department of Health and Human Services (HHS), National Alliance on Mental Illness (NAMI). (2007). NAMI: National Alliance on Mental Illness: Mental health support, education and advocacy [Website]. http://www.nami.org
- HHS, National Institute on Drug Abuse. (2007). National Institute on Drug Abuse [Website]. http://www.nida.nih.gov
- HHS, National Institute of Mental Health (NIMH). (2007). NIMH [Website]. http://www.nimh.nih.gov
- HHS, Substance Abuse and Mental Health Services Administration. (2007). The Substance Abuse and Mental Health Services Administration [Website]. http://www.samhsa.gov
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