**2. Psychological reactions after disaster**

#### **2.1 Common reactions and symptoms following a disaster**

Following the occurrence of severe mental stress caused by a disaster, a group of symptoms and disorders appear in people, which can have an adverse effect on their performance. In some people, we are faced with only one symptom, and in others, we are faced with a combination of symptoms that, if not addressed, can lead to chronic mental disorders. The degree of influence of people from the surrounding events is essentially a function of the previous vulnerability, the extent of the disaster, and the amount of destruction and loss, as well as the status of support and timely attention to the psychosocial issues of the people [16]. Symptoms that are commonly seen in disaster survivors include:

1.Disturbing thoughts: Among the most unpleasant phenomena that children and adults experience after traumatic events are disturbing memories, thoughts,

and feelings. These memories may come unread and unwanted at any time of the day due to depression or in response to environmental reminders. They may appear at night in the form of nightmares or terrible dreams [17]. Since these memories are very bright and scary, they impose a lot of psychological pressure on the person. Many people are afraid of going crazy or losing control after such experiences. Therefore, one of the main goals of group counseling sessions is to make people understand that such reactions are normal and do not cause insanity, and they should also be taught skills to control these recurring memories so that they can deal with these memories and have control over them.


and are affected by other symptoms, such as the repetition of disturbing thoughts [24]. In fact, the various symptoms seen in people following disasters can lead to the formation of a vicious cycle and ultimately intensify each other. On the other hand, daily fatigue and lack of energy renewal during the night hours can cause damage to the cardiovascular system and the immune system and make a person susceptible to the occurrence of diseases.

5.Grief reaction: Grief is a reaction that occurs naturally in response to the loss and lack of what a person has depended on. Loss can be due to the loss of relatives and friends, assets and belongings, or a person's future career [25]. It should be remembered and emphasized that grief is completely normal, and we naturally expect such a reaction after unexpected events [25]. Grief reaction is a set of emotions that are different depending on the culture that governs the society. Naturally, this reaction is expected to resolve within two months. The severity of the symptoms and the time of their occurrence also play a role in determining whether this reaction is normal or abnormal. In general, the intensity of the mourning reaction should be proportional to the loss that the person is facing, to be resolved within 2 months, and not started late. Its symptoms should gradually decrease, and the bereaved person should be able to return to their previous level of performance within 2 months. In fact, mourning is a process that ultimately leads to the acceptance of abandonment by humans [26]. In some cases, people are wrongly prohibited from expressing their feelings, crying and mourning, and refraining from expressing feelings is interpreted as "resistance." In certain conditions, the probability of morbid grief increases, including in cases where the loss was very extensive, accompanied by great panic, or happened very quickly, in cases where the person already had a high vulnerability, was isolated, and lacked a social support network, or suffered from disorders such as depression [26]. Also, people who somehow consider themselves involved in the occurrence of the accident or the extent of its effects are more prone to abnormal reactions during mourning. The role of specialists who work in the field of psychosocial interventions is to facilitate the mourning process. In order to achieve this goal, we can also seek help from religious leaders.

#### **2.2 Common mental disorders following disasters**

The executive policy of mental health officials should be focused on normalizing reactions caused by disasters. In fact, it should be acknowledged that most of the reactions that occur after disasters are natural reactions to the very unusual incident. One of the general goals of psychosocial support during disasters and unexpected events is to empower the victims and improve their adaptive mechanisms. A diseaseoriented approach in community-based psychiatry in disasters will be a serious obstacle to reaching these goals. Therefore, the use of the words disease and disorder should be done very carefully. Of course, there is no doubt that depriving the victims of proper treatment when a definite diagnosis of a psychiatric disorder is involved is also an unethical act, and in necessary cases, there may be a need for more serious treatments, even hospitalization.

The most common disorders that are observed after unexpected events are: acute stress disorder, post-traumatic stress disorder, depression, abnormal grief, somatic disorders, and various anxiety disorders [27].

	- Feeling numb and emotional indifference
	- Decreased awareness of the surrounding environment
	- The feeling of unreality of oneself or the feeling of unreality of the world around us
	- Psychogenic forgetfulness

The traumatic event may be repeated by itself or following thoughts, dreams, sensory errors, repetition of memories by the people around, or the feeling of the incident happening again for the survivor [28]. Avoidance is one of the common and obvious symptoms of this disorder because the person tries to avoid recalling painful memories and re-experiencing the arousal caused by them. Different types of sleep disorders, excitability, problems in concentration, restlessness, excessive ringing, and severe startle reflex are some of the other symptoms that we expect in this disorder [28]. The main difference between this disorder and post-traumatic stress disorder is the duration of the illness, this disorder lasts between 2 days and 4 weeks, and if it is not resolved in this period of time, it turns into post-traumatic stress disorder. The affected person clearly suffers a drop in personal and social functioning [29].

