Physical reactions to traumatization can include gastrointestinal disorders, respiratory difficulty, cardiovascular distress, and/or chronic
psychological symptoms of disorientation, shock, confusion, apathy, and emotionallability and/or numbness. Survivors may harbor feelings of resentment toward those spared serious losses or toward caregivers or suffer self-blame with accompanying depression. Anger may be projected toward significant others, including clergy, or be introjected, becoming depression. Anxiety, irritability, depression and moodiness, numbing of affect, mental flashbacks, the developing of negative attitudes, chemical coping, markedly increased environmental and interpersonal vigilance, a flight into activity, increased personal cynicism or inter-personal hostility, and sexual hyperactivity or incapacity are among the symptoms that can emerge. Traditional psychological defense mechanisms such as denial, regression, reaction-formation, intellectualization, and rationalization may also be used to cope. People who prefer direct coping may act to alter the sources of stress, provide emergency interventions for others, participate in disaster debriefing, seek psychological counseling, and actively reconstruct their personal, family and social lives. However, those who tend to use indirect coping may try to alter the perceived significance of the stress or events through denial or burying oneself in activity. If adaptation or effective resistance to a trauma is not possible, unresolved distress reactions may reveal themselves physically and psychologically.