Traumatic Stress Studies Division

Resources

What Are the Traumatic Stress Effects of Terrorism?:
A National Center for PTSD Fact Sheet

On Tuesday, September 11, 2001, the nation was forever changed. Following the single largest terrorist attack ever experienced by this country, thousands are dead or missing, tens of thousands know someone who was killed or injured, and many more have witnessed or heard about the attack through media sources and other mediums. Thus, the impact of this magnitude of terroristic violence will affect people at all levels of involvement: victims, bereaved family members, friends, rescue workers, emergency medical and mental health care providers, witnesses to the event, volunteers, members of the media, members of the community, the state, the nation, and the world.

Terrorism erodes a sense of security and safety at both the individual and community level. It can challenge the natural need of humans for the world to be predictable, orderly and controllable (Lerner, 1980). Studies have shown that deliberate violence creates longer lasting mental health effects than natural disasters or accidents. The consequences both for individuals and the community are prolonged, and survivors often feel that injustice has been done to them. This can lead to anger, frustration, helplessness, fear, and a desire for revenge. Studies have shown that acting on this anger and need for revenge can increase feelings of anger, guilt, and distress, rather than decreasing them.

However, the mechanisms of natural recovery from traumatic events are strong. Many trauma experts (Staab, Foa, Friedman) agree that the psychological outcome of our community as a whole will be resilience, not psychopathology. For most, fear, anxiety, reexperiencing, urges to avoid, and hyperarousal symptoms, if present, will gradually decrease over time.

Research has shown that those who are most at risk for more severe traumatic stress reactions such as posttraumatic stress disorder (PTSD) are those who have experienced the greatest magnitude of exposure to the traumatic event, such as victims and their families. In this incident, many surviving rescue workers will also have direct relationships, or indirect exposure to those who are missing or killed, and will therefore be coping with their own losses as well as with the demands of the rescue mission. A particularly difficult task for these rescue workers will be the removal of the casualties and other aspects of body identification and removal, which have been shown to be particularly traumatic and associated with higher rates of PTSD.

Information from Past Incidents of Terrorism

Fortunately, there have been very few terrorist attacks in the United States. One implication, however, is that there is little known about how people are affected by terrorism. A consistent finding is that, while most individuals exhibit resilience over time, people most directly exposed to terrorist attacks are at a higher risk to develop PTSD. Problems with anxiety, depression, and substance use are also commonly reported. Predictors of PTSD include being closer to the attacks, being injured, or knowing someone who was killed or injured. Those who watch more media coverage are also at higher risk for PTSD and associated problems. Research from both domestic and international terroristic events sheds some light on the heightened risk for traumatic stress reactions in individuals exposed to these events:

Oklahoma City Bombing

• Almost half of survivors directly exposed to the blast reported developing problems with anxiety, depression, and alcohol and more than one-third reported posttraumatic stress disorder (PTSD). Predictors of PTSD, anxiety, and depression included more severe exposure, female gender, and having a psychiatric disorder before the bombing (North, Nixon, Shariat, Mallonee, McMillen, Spitzanagel, Smith, 1999).
• More than a year after the bombing, Oklahomans reported increased rates of alcohol use, smoking, stress, and PTSD symptoms as compared to citizens of another metropolitan city (Smith, Christiansen, Vincent, Hann, 1999).
• In a group of adults who sought mental health services, reactions of being nervous and being upset by how other people acted when the bombing occurred was predictive of PTSD (Tucker, Dickson, Pfefferbaum, McDonals, Allen, 1997)
• Children who lost an immediate family member, friend, or relative were more likely to report immediate symptoms of PTSD than children who had not lost a loved one (Pfefferbaum et al, 1999).
• Two years after the bombing, 16 percent of children and adolescents who lived approximately 100 miles from Oklahoma City reported significant PTSD symptoms related to the event (Pfefferbaum et al, 2000). This is an important finding because these youth were not directly exposed to the trauma and were not related to killed or injured victims. PTSD symptomatology was higher in those with greater media exposure and those with indirect interpersonal exposure, such as having a friend who knew someone killed or injured (Pfefferbaum et al, 2000).

Lockerbie Disaster: The Crash of Pan Am Flight 103

• Almost 3/4 of a group of people seeking psychological damages following the crash of Pan Am Flight 103 reported PTSD (Brooks, McKinlay, 1992). More than 50 percent continued to have PTSD three years after the crash (Scott, Brooks, McKinlay, 1995).

Subway Attack in Japan

• Common experiences of those who were exposed to poisonous gas in the subway included anxiety, fear, nightmares, insomnia, depression, and fear of subways (DiGiovanni, 1999).

As indicated above, rates of distress and posttraumatic symptoms have been found to be high in individuals studied following terrorist events. Ultimately, reducing the risk of traumatic stress reactions is best accomplished by abolishing trauma in the first place by preventing war, terrorism, and other traumatic stressors. The next best approach is to foster resilience and bolster support so that individuals have better coping capacity prior to and during traumatic stress. The third best option is early detection and treatment of traumatized individuals to prevent a prolonged stress response.