Young Norwegian people who planned to spend late-summer days on decorating their bedsits, buying schoolbooks or going for that last swim are in deep mourning. They are challenged by psychological reactions to traumatic events of a nature that we can hardly comprehend.
In the days, weeks and months to come, many of the young people who returned from Utøya island and their families will seek advice and help. Many will nevertheless be reluctant to call their GP, crisis management teams, municipal services or psychiatric services. In addition, adolescents are especially vulnerable to interruptions in such contact, because they feel that the health services cannot fulfil their needs. Listening to how they feel, being generous with your time and not giving up could be your most important contribution as a doctor.
Post-traumatic stress
Post-traumatic stress
In our encounter with afflicted patients and their families, we need to take two general considerations into account. On the one hand, it is essential to respect natural processes of healing. Exaggerated attention to disorders and symptoms during the initial period may delay healing. On the other hand, the increased risk of long-term health problems after traumatic incidents will require enhanced alertness and follow-up of symptoms over time. Some will therefore need long-term support and interventions from the health services. Post-traumatic stress reactions are common, understandable and expected effects. They may nevertheless be experienced as extremely up-seting – especially reactions that reoccur frequently. Three different types of symptoms can be expected: reliving the event, avoidance and increased physiological response.
Reliving the event means that thoughts and images from the incident keep coming back, when awake as well as in dreams. Many also experience so-called «flashbacks», which are perceived as though the event or parts of the event are actually reoccurring. Furthermore, being reminded of the incident may evoke intense emotions or physiological reactions.
Avoidance and emotional numbness can be played out at an internal level by the adolescents avoiding the event in conversations or in their minds, or at an external level by them refraining from undertaking activities or visiting places that remind them of the events. Emotional numbness concerns the experience of emotional change, when adolescents for example lose interest in activities that were important to them before the event, or when they feel alienated from close family members or friends.
Increased physiological response is associated with autonomous reactions after the event that manifest themselves in difficulties in falling asleep, frequent awakenings, a lower threshold for outbursts of anger, and difficulties in concentrating. The senses are on higher alert than normal, and react to lower stimulations than they otherwise would: for example a slamming door may evoke a strong reaction. Children and adolescents may become restless and unfocused, or display changes in their pattern of behaviour.