It is a process that is usually gradual in onset. Examples include being witness to mass violence or listening to first hand accounts of traumatised people. ASD appears relatively quickly after exposure to a particular stressor and, by definition, resolves within a month. It includes a spectrum of emotional reactions, cognitive changes such as confusion, and symptoms of mental and physical hyperactivity. PTSD symptoms appear from one month to three months after a given event.
Symptoms usually involve flashbacks to the events and a state of being hyper-alert.
Symptoms may become chronic and extremely debilitating. In their attempt to find a new internal equilibrium, relief workers may also respond to unresolved stress with more subtle behavioural changes. This reaction may be more common in the younger, more idealistic relief worker. By contrast, avoidance reactions of distancing, withdrawal and denial may be more common among experienced personnel. Finally, relief workers may exhibit self-destructive behaviours such as working to the point of exhaustion, consuming excessive amounts of alcohol, or engaging in unprotected sexual encounters.