Signs of distress

There are some signs of distress people may exhibit that you can look out for in the hours and days following a traumatic event.

Uncertainty, loss of control and disruption to normal supports are key features of such events that may lead to signs of distress in anyone, not just those exposed to specific traumas. These signs may be less easy to spot in people with a learning disability, autism and people affected by dementia or other cognitive differences.

We will now discuss some common reactions to stress, that maybe useful to help establish if someone is showing signs of distress. These include emotional, cognitive, social and physical reactions.

Emotional reactions

These are reactions connected to how a person is feeling and how they perceive they are coping with a situation. A person may share feelings of:

• Fear and anxiety
• Helplessness
• Hopelessness/demotivation
• Guilt
• Anger or frustration
• Sadness
• Loneliness

Cognitive reactions

These are reactions that are connected to a person’s thoughts, or their ability to manage their thoughts. Reactions may include:

• Impaired concentration
• Confusion or disorientation
• Ruminating and intrusive thoughts (ones that come into your mind when you don’t intend to think about them)
• Dissociation (feeling disconnected from yourself or the world around you)
• Denial
• Hypervigilance (being always on alert)
• Impaired memory

Social reactions

These are reactions connected to how a person interacts on a social level, and looks after their basic personal needs. You may see signs such as:

• Reduced confidence or self-esteem
• Withdrawal
• Irritability
• Interpersonal conflict
• Avoidance
• Lack of self-care

Physical reactions

Some people will have actual somatic complaints that appear in the absence of a physical cause, and any bodily system can be affected. Common reactions are:

• Breathing difficulties
• Increased heart rate and blood pressure
• Sweating
• Palpitations
• Muscle tension
• Gastrointestinal symptoms
• Somatic symptoms
• Hyper-arousal (being in a state of high alert, constantly tense and ‘on guard’)
• Headaches
• Change in eating habits
• Reduced energy
• Sleep problems, e.g. insomnia

Advice for supporting those with cognitive difference

People with a learning disability, autism, dementia and other cognitive differences may show distress differently. Do not assume that behaviour that is different to ‘normal’ is actually different for that individual – but also do not assume that people’s behaviours are different just because of their cognitive difference.

Many people will be able to discuss how they are being affected and whether there has been any change to their thoughts, feelings or actions. Those close to the person may be able to help and people may be able to share information such as learning disability or autism passports or other records that set out how the person usually reacts and how to spot signs of distress or anxiety.