Disaster Anniversary Reactions

James J. De Santis, Ph.D.
Post Office Box 894, Glendora, CA 91740-0894
(818) 551-1714

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The impact of disasters on our patients and clients is something we are
aware of as mental health professionals. We are also aware of the
phenomenon of the "anniversary reaction." The intent of this article is to
offer some observations that may stimulate clinical reflection in anticipation
of disaster anniversaries.

An anniversary reaction may be defined as "behavior, symptoms, dreams,
etc. that occur on an anniversary of a significant experience; their
time-specific relationship to the original experience is rarely recognized by
the subject and they appear to be a type of acting-out, i.e. an attempt to
master through reliving rather than through remembering" (Campbell, 1981).

A psychological anniversary can be demarcated by a specific calendar date.
"...Anniversary dates are very important. They may act like trip-wires, often
resulting in emotional outbursts or setbacks even for those believed on the
road to recovery" (Marrs, 1985). They can also be associated with a diffuse
time of year, such as the season.

Hull, Lane, & Gibbons (1993) suggest an alternate form of the anniversary
reaction whose timing is determined by the duration of psychotherapy.
Calculated from the beginning of treatment, "a ‘resonance' is set up that
links current events with the previous traumatic series....If other events
'line up,' particularly other losses from the patient's past and current life,
destructive acting-out may ensue" (Hull, at el, 1993). They relate this to
early childhood trauma; however, this may apply to disaster as well. For
example, an individual who has survived two disasters six months apart
might re-experience peak symptoms six months into treatment

While traumata can be multiple, so to can be sequelae. "Anniversary
reactions...may present in various forms, including somatic symptoms and
diseases, depression, psychosis, suicide, and homicide" (Gabriel, 1992).
Certainly they can present in as varied a range as symptoms shortly
following a disaster. It is probably important to recognize that trauma
symptoms should be distinguished from mental illness and that the approach
to treatment is to normalize the experience of symptoms (Kilpatrick, 1994).

Anniversary reactions may most tend to occur when a primary less has not
been worked through and a secondary, symbolic, or future loss occurs.
Treatment involves focusing on "the incomplete mourning" (Hull, at el, 1993)
inevitable in the original loss. Disaster anniversary reactions in Los Angeles
may be all the more complicated if multiple disasters have prevented the
complete processing of any single event or loss. Individual traumata
predating disaster can certainly add yet another wave of emotional
reverberation.

An anniversary marks a time of heightened vulnerability. "Often, predicting
anniversary reactions or discussing them with the patient in advance can be
useful. Even if it does not prevent the anniversary reaction, a cognitive
framework is created that helps to mitigate the damaging effects.
Subsequently, these reactions should be connected to the original
traumatic loss through interpretation. Losses in the present need to be
connected to losses in the past" (Hull, at el, 1993).

While an anniversary reaction may not be purely conscious recollection and
grief, an anniversary may certainly be an "occasion for taking stock"
(Kilpatrick, 1994) and constructively processing losses through mourning.
Such feelings may also be triggered by events not necessarily timed one
year after a trauma but associated with some aspect of the trauma--like a
family holiday following the death of a loved one--and are probably better
conceptualized as grief and mourning rather than as an anniversary reaction
(Wirth, 1994).

On the one hand, each subsequent anniversary may produce decreasing
levels of distress if the trauma is being successfully worked through; on the
other hand, each anniversary may be complicated if the individual is
retraumatized in the meantime (Kilpatrick, 1994).

Just as post-traumatic reactions may be triggered at any time by a stimulus
that resembles in form the original trauma, anniversaries are temporal
"echoes of the original trauma" (Haley, 1978) that may harbor clues "to the
aspects of the trauma that remain most conflictual to the person"
(Scurfield, 1993). Factors unique to the individual must be evaluated in
order to anticipate, recognize, and fully understand any anniversary
reaction, including the context of personal history, background, and culture;
including the severity and type of disaster and losses sustained; and
including the person's aspirations and dreams.

Anniversary reactions are an important phenomenon. Their recognition in our
roles as therapists to individuals and families and as consultants to
organizations will better serve a beleaguered community.

References

Campbell, R. (1981). Psychiatric dictionary (5th ad.). New York: Oxford
Univeristy Press.

Gabriel, M. (1992). Anniversary reactions: Trauma revisited. Clinical social
work joumal, 20(2), 179-192.

Haley, S. (1978). Treatment implications of post-combat stress response
syndromes for mntal health professionals. In C. Figlay (Ed.), Stress disorders
among Vietnam veterans (pp. 254-267). New York: Brunner/Mazel.

Hull, J., Lane, R., & Gibbons, B. (1993). Early object loss and "secret
anniversaries of the heart." Psychoanalytic psychology, 10(1), 77-91.

Kilpatrick, M. (1994). Personal communication.

Marrs, R. (1985). Why the pain won't stop and what the family can do to
help. In W. Kelly (Ed.), Post traumatic stress disorder and the war veteran
patient, (pp. 85-101). New York: Brunner/Mazel.

Scurfield, R. (1985) Post-trauma stress assessment and treatment:
Overview and formulations. In C. Figley, (Ed.), Trauma and its wake: The
study and treatment of post-traumatic stress disorder, (pp. 219-256). New
York: Brunner/Mazel.

Wirth, B. (1994). Personal communication.

Thanks to the following individuals for their review and comments: Greg
Ritzhaupt, M.A., Bonnita Wirth, L.C.S.W., Ph.D., & Margaret Ann Kilpatrick,
M.S.W, B.C.D.