Disaster psychology

• TYPE OF PSYCHOLOGY: Emotion; sensation and perception; social psychology; stress

Disaster psychology examines how emotional trauma can be assessed and treated during emergencies and investigates disaster-related conditions such as post-traumatic stress disorder.

Introduction

Disaster psychology deals with the reactions and responses of victims and witnesses of natural and artificial catastrophes, such as earthquakes, tornadoes, hurricanes, airplane crashes, train wrecks, toxic spills, industrial accidents, fires, explosions, terrorism, and school shootings, which often involve mass casualties. In the 2020s, the American Red Cross (ARC) estimated that it responded to over 65,000 disasters requiring external emergency aid every year, ranging from single-home fires or floods to national catastrophes. In addition, international events, such as Australia’s bushfires (2019 and 2020), the conflict in Ukraine (2022–), and the Turkey-Syria earthquake (2023) require the assistance of emergency workers from around the world.

Mental health professionals use their skills to help trauma survivors and relief workers cope with the drastic changes and shock associated with tragedies. Many mental health professionals consider disaster service a social responsibility. Even though people may not have obvious physical wounds, they usually experience emotional pain. Disaster mental health personnel often serve as media contacts to educate the public about ways to resume normalcy.

Short-term crisis mental health services assess the psychological status of affected populations, provide grief counseling, and initiate individual and community recovery. They provide emotional support when relatives identify bodies at morgues. Volunteers help survivors who temporarily experience survivor guilt, anxiety, mood swings, sleep disturbances, social withdrawal, and depression by reassuring them that they are reacting normally to abnormal, unexpected, and overwhelming situations that have disrupted their lives and that their heightened emotions will eventually lessen.

Long-term disaster psychology recognizes how catastrophes can result in some participants having post-traumatic stress disorder and other delayed or chronic reactions such as nightmares and flashbacks, which are sometimes triggered by disaster anniversaries or sirens. Therapists also deal with disaster-related conditions such as substance use disorders, irrational fears, and self-mutilation.

In addition to providing practical services, some disaster psychologists conduct research to develop more effective methods to help people during disasters. Procedures are developed to be compatible with varying coping styles for adults and children. Disaster psychologists often conduct workshops and conferences to teach techniques based on prior experiences to mental health relief workers, health professionals, and community leaders. Preparation and planning for future disasters is an important component of disaster psychology. Disaster mental health providers educate representatives of schools, municipalities, humanitarian organizations, and corporations about disaster readiness.

Disaster mental health professionals create educational materials to inform people about how to cope with disasters. Most disaster psychology literature addresses how disasters make people feel vulnerable and helpless and suggests practicing psychological skills to acquire some control during volatile situations. For example, after the September 11, 2001, terrorist attacks on the United States, many disaster psychological pamphlets emphasized how to keep in perspective the actual personal risks of unknown threats such as anthrax contamination and biological warfare.

Historical Development

Mental health professionals developed disaster psychology methods based on medical triage techniques and practical experiences with disasters. Several notable disasters were crucial to establishing disaster mental health services. When 491 people died in Boston’s Cocoanut Grove nightclub fire in 1942, Erich Lindemann investigated how survivors reacted emotionally. Disaster mental health authorities often cite Lindemann’s trauma and stress study as the fundamental work addressing disaster crisis theory. Pioneers in this emerging field used studies of military and civilian reactions to war-related stress and anxiety.

In 1972, a dam collapse resulted in the flooding of Buffalo Creek in West Virginia, causing 125 deaths. Approximately five thousand people lost their homes. When survivors sued the dam’s owner, attorneys hired mental health consultants, who collected information about the psychological impact of the disaster on the community. This information was evaluated twenty years later, when investigators conducted a follow-up psychological study of survivors. The 1974 Disaster Relief Act stated that Federal Emergency Management Agency (FEMA) emergency funds could be used for mental health services. The Three Mile Island nuclear meltdown in 1979 revealed the need for mental health disaster services to be better coordinated and focused.

A decade later, the ARC emphasized that coordinated professional mental health response procedures comparable to medical health response plans were crucial. Often, ARC nurses who were not qualified to provide psychological services encountered disaster survivors and relief workers in need of such help. The situation was exacerbated by the succession of major disasters in 1989: the Sioux City, Iowa, airplane crash in July; Hurricane Hugo in the Caribbean and southeastern United States in September; and the Loma Prieta earthquake in the San Francisco Bay area in October. Psychologists who assisted airplane crash survivors and their families suggested that the American Psychological Association (APA) work with the ARC to establish a national plan for the training of disaster mental health personnel.

Mental health teams were assigned to accompany ARC relief workers when Hurricane Hugo occurred. These volunteers were already exhausted when the San Francisco earthquake took place, but instead of returning home, relief personnel were asked to transfer to San Francisco. Unfamiliarity with inner-city and ethnic cultures, language barriers, and long-duration service assignments intensified relief workers’ stress, and the need for mental health services for relief workers became apparent.

Professional Organization

Although mental health professionals provided disaster services throughout the twentieth century, disaster psychology emerged as a professional field during the 1990s. In 1990, the APA financed a California Psychological Association disaster-response course, and the ARC assisted with the class. Tornadoes in Illinois in the spring of 1991 prompted the Illinois Psychological Association to respond to the ARC’s request for mental health services. The first community request for disaster mental health services occurred after a tornado devastated Sherwood, North Dakota, in September 1991. Citizens sought help for their children in coping with the damage and casualties.

The ARC established the Disaster Mental Health (DMH) services by November 1991 and issued guidelines for training, certification, and service. Psychologists attending ARC disaster training began offering courses in their regions. The APA agreed to collaborate with the ARC the next month. Representatives of the APA and ARC decided that the APA’s Disaster Response Network (DRN) would prepare psychologist volunteers to offer free mental health services to survivors and relief workers at disaster scenes. After Hurricane Andrew hit Florida in 1992, approximately two hundred DRN psychologists helped survivors with the ARC. The APA has established task forces to evaluate mental health responses to various catastrophes.

The APA sponsors a Committee on Psychiatric Dimensions of Disaster (CPDD), formed in 1993 after three years of development as a task force. Members of this committee supply educational information to help psychiatrists provide disaster-related services. The committee seeks to advance the field of disaster psychiatry through training and research to determine the optimum psychiatric treatment for disaster survivors. Members distribute materials to district branches to aid local response to potential disaster situations. The American Psychiatric Association also posts information about disaster topics on its website.

The APA’s emergency-services and disaster-relief branch cooperates with other mental health groups and emergency services to prepare professionals to respond appropriately and effectively to psychological aspects of disasters. Multiorganization conferences in 1995 and 1996 clarified mental health professionals’ roles during disasters and approved APA goals. Facing such challenges as 2005’s Hurricane Katrina demonstrated the need for such coordinated efforts to aid survivors.

Psychiatrists often feel limited by the ARC's prohibition of psychiatrists from prescribing medications while acting as ARC volunteers, and some mental health professionals formed local groups to intervene during disaster relief. Disaster Psychiatry Outreach (DPO) was established after the 1998 Swissair Flight 111 crash as an effort to provide better disaster mental health services in the New York City vicinity. Most DPO volunteers are qualified to prescribe medications for survivors and their families. Ethical and legal concerns specific to disaster mental health services provided by any source include abandonment of survivors and solicitation of patients.

Disaster Procedures

At a disaster scene, mental health professionals aid medical emergency workers in identifying people who are behaving irrationally. Disaster psychologists help people deal with injuries or losses of family members and homes. Specific emotional issues might include disfigurement, loss of body parts, or exposure to grotesque scenes. Psychologists soothe disaster survivors undergoing sudden surgical procedures.

Disaster survivors and relief workers who initially appear resilient may later exhibit signs of psychological distress. Mental health professionals encourage those at risk of developing psychiatric disorders to seek support. The APA’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published in 2022, outlines a broad range of trauma exposures that can trigger post-traumatic stress disorder (PTSD), including indirect experiences such as repeated exposure to traumatic details (as in first responders). It also distinguishes acute stress disorder (ASD), which shares symptoms with PTSD but typically resolves within a month. Additionally, clinicians now recognize complex PTSD (C-PTSD)—a condition resulting from prolonged, repeated trauma such as chronic abuse or captivity—and prolonged grief disorder (PGD), a codified diagnosis describing intense, persistent mourning that disrupts daily functioning long after a loss. These evolving diagnostic frameworks have expanded the scope of disaster psychology, allowing practitioners to better tailor interventions to diverse trauma experiences and timelines.

Disaster mental health professionals draw on research and field experience to develop and refine various intervention strategies to support survivors and emergency personnel. While Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) were once widely adopted—particularly for first responders experiencing trauma—their effectiveness has since been scrutinized. Studies have shown that CISD may inadvertently reinforce trauma or hinder natural recovery if applied improperly or too soon. As a result, many mental health organizations in the 2020s recommend Psychological First Aid (PFA) as the gold standard for early intervention. PFA emphasizes practical support, stabilization, and connection to longer-term care without forcing emotional processing before a person is ready.

The need for emotional care among emergency personnel remains high. For example, after the 1995 Oklahoma City bombing, approximately 20 percent of relief workers sought psychological support, and in the aftermath of the September 11, 2001, terrorist attacks, around 2,000 emergency responders accessed counseling services. During the COVID-19 pandemic, telehealth and digital platforms became essential for delivering remote crisis counseling, psychological triage, and ongoing mental health care to survivors and frontline workers.

Mental health professionals increasingly collaborate through the World Health Organization, Médecins Sans Frontières, the International Federation of Red Cross and Red Crescent Societies, and many non-governmental organizations. These groups aid in coordinating psychosocial responses to large-scale disasters and humanitarian crises using cultural competence and context-sensitive approaches. Responses to trauma and healing processes vary significantly across cultures, requiring mental health interventions to be adapted accordingly. PFA, for example, has been translated and modified for use in dozens of countries, aligning with local customs, languages, and belief systems.

Research topics include evaluation of how PTSD is related to disasters or how heroes react to public attention, disaster-stimulated life changes such as marriage or divorce, stress reactions of secondary survivors who are not directly affected by disasters, and variables such as gender, religious affiliation, and ethnicity. Children, adolescents, and older adults have unique needs during and after disasters. Other possible research groups include unhoused individuals, individuals with disabilities, and people who were medically or mentally ill at the time of the disaster. Researchers use computer and technological advances to enhance studies of data and model disaster scenarios.

Internationally, academic programs, symposiums, and conferences explore disaster-related mental health topics. The University of South Dakota’s Disaster Mental Health Institute offers a comprehensive curriculum of undergraduate and graduate disaster psychology courses to train ARC-approved disaster mental health personnel.

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