AP Photo/John Raoux

People embrace and bow their heads as nearby church bells ring during a vigil Tuesday, Oct. 3, 2017, in Orlando, Fla., to show solidarity with the victims of the shooting in Las Vegas. Authorities said Stephen Craig Paddock broke windows on a Las Vegas casino and began firing with a cache of weapons Sunday, killing dozens and injuring hundreds at a country music festival.

The survivors and families devastated by the killing spree in Las Vegas on Oct. 1 face more than physical and financial obstacles in their path to recovery.

The psychological damage done could be just — if not more — crippling. Many develop Posttraumatic Stress Disorder (PTSD), a mental illness caused by an external traumatic event. It doesn’t have to be only deadly gunfire; PTSD can result from surviving earthquakes or hurricanes — or something as personal as domestic abuse or the loss of someone in your life.

Symptoms can consist of but are not exclusive to depression, emotional detachment, jumpiness and flashbacks. They can manifest into elevated heart rate and heightened hearing, or worse.

Dr. Maria Lymberis, whose office is in Santa Monica, has been a board-certified practicing psychiatrist for more than 30 years and is a Distinguished Life Fellow recipient from the American Psychiatric Association. PTSD is one of the conditions that she regularly sees patients for after they have undergone or witnessed some significant trauma.

She said one of the most significant traumas for people is warfare, “whether organized warfare or random acts of violence like the Las Vegas event.”

“Not everybody who was present on the site and survived, or is a relative of a person who was there and either died was injured or saw these things, is by definition likely to get PTSD. But people who were already [psychologically] vulnerable, for all kinds of reasons, can become fully symptomatic and quite sick,” Lymberis said.

“There is no one-size-fits-all. It depends how lucky you have been up until that time. … People who were already vulnerable for all kinds of reasons, can become fully symptomatic and quite sick.”

“In our Western civilized world you reach the ‘age of maturity’ at 21. But the brain doesn’t know that. Each person is one of a kind. You cannot say how long it will take anyone to recover. It could be you have tremendous resilience, and you happen to be very lucky. But I can tell you, if you have pre-existing vulnerabilities with adversity throughout your development — including adolescence — your chances of recovery could take years.”

She said people with PTSD can develop somatic symptom disorders if they don’t get proper psychological help.

“The brain controls every inch of everybody’s body. If you cannot deal with your feelings, where is the stress going to go? In your organs. You might start drinking, overeating, use drugs, or sit on the couch watching TV and doing nothing.”

At press time on Wednesday, Oct. 4, 59 persons were victims of the mass shooting during a concert in Las Vegas hailed from Southern California, and the number could still rise as more relatives identify the dead.

Among them is Melissa Ramirez, 26, lived in North Hollywood and worked for the Automobile Club of Southern California.

Ramirez was a sports fan who loved the Philadelphia Eagles, Los Angeles Lakers, Dodgers and USC Trojans. She posted a picture of herself and a friend at the Las Vegas music festival on Instagram on Saturday.

“Please keep the Ramirez family in your prayers,” a relative wrote on a GoFundMe page. “Keep them in your thoughts and celebrate the life of a young woman who has gone to be with the Lord.”

Another victim was John Phippen, 56, of Valencia, owner of a remodeling company known as JP Specialties. He attended the country music festival with his son, Travis, who was shot in an arm but helped treat more than a dozen wounded people in the crowd.

“He was my best friend,” Travis told the Los Angeles Times about his father. “He never did anything wrong to anybody. He was always kind and gentle.”

Also killed was Susan Smith, 53, an office manager for the Simi Valley Unified School District. She worked for the district for 16 years.

The man identified as the shooter, Stephen Paddock, sprayed hundreds of rounds from the 32nd floor of the Mandalay Bay Hotel and Casino on an unsuspecting crowd attending an open air country music festival on the strip. The gunman killed himself as police were entering his hotel room. The motive for this attack is unknown.

Paddock, 64, was a former Southern California resident who graduated from Poly High School in Sun Valley and Cal State University, Northridge. He also attended Richard Byrd Middle School.

“As California State University, Northridge shared in a written statement, our hearts and thoughts are with the victims, survivors, first responders and loved ones impacted by this horrific mass shooting,” CSUN officials said in a statement released on Tuesday, Oct. 3.

“Late Monday, CSUN officials learned that Stephen Paddock, the perpetrator of Sunday’s mass shooting in Las Vegas, attended the university, completing a degree in Business Administration in 1977. Immediately, CSUN’s Chief of Police was contacted, and university officials shared this information with investigators in Las Vegas.

 “While no words can truly express the loss and sadness the nation feels today, the CSUN community offers its profound sympathies to those affected by the heinous violence that occurred in Las Vegas,” the statement said.

Former Los Angeles City Councilman and state Sen. Richard Alarcon told media  he knew Paddock while growing up and recognized his face when his picture was released after Sunday’s shooting.

“I just recognized his face, his hair color, his eyes,” Alarcon said. “He always had big eyes when he was a kid. The face was recognizable.

“… He was an average kid, very pleasant,” said. “He wasn’t overbearing. … He didn’t have the most outspoken personality. We’re talking about when we were 8 to 12 years old. He was just an average, American kid.”

The Associated Press, citing the federal Office of Personnel Management, reported Tuesday that Paddock worked as a U.S. Postal Service letter carrier from 1976-78, presumably while he was living in Southern California and attending CSUN.

He then worked as an Internal Revenue Service agent until 1984, then spent 18 months in a defense auditing job, according to the report.