Psychological Reactions to Terrorism: An Overview

Presented by William E. Schlenger, Ph.D.

Director, Center for Risk Behavior and Mental Health Research,
Research Triangle Institute

P.O. Box 12194 · 3040 Cornwallis Road · Research Triangle Park, NC 27709
Phone: 919-541-6372 · Fax: 919-485-5589 · bs@rti.org · www.rti.org

Extreme Events

A number of studies have provided empirical documentation of psychological reactions to a wide variety of "extreme events" (e.g., natural disasters, combat, sexual assault). Generally, events involving intentional violence-e.g., terrorism, assault--produce more intense psychological reactions than natural disasters (e.g., hurricanes, earthquakes)

Types of Reactions to Extreme Events

Two types of reactions:

a. Mild to moderate distress-e.g., anger, fear, sadness--that is typically self limiting (transient)
b. Clinically significant psychological symptoms, typically in the form of the syndrome known as posttraumatic stress disorder (PTSD)

Findings of Initial September 11 Studies

Earliest studies, based on random digit dialing telephone surveys, reported widespread mild to moderate distress across the US. Later evidence is consistent with the hypothesis that much of the distress that appeared in the immediate aftermath of September 11 was transient. PTSD attributable to September 11 PTSD is limited largely to those who are in some way "connected" to the events-e.g., were at one of the crash sites, had friends/relatives injured or killed.

Are Some Groups More Susceptible?

Prior research has documented the following differences in PTSD prevalence rates among people exposed to extreme events:

a. Females more likely than than males to develop PTSD
b. Younger age at exposure more likely than older
c. Minority race/ethnicity more likely than majority

Is PTSD Related to Media Exposure?

Some studies indicate that those who spent greater amounts of time viewing televised accounts of September 11 events are more likely to have PTSD. Although this finding can be interpreted in a variety of ways, we view the current evidence as consistent with the hypothesis that TV viewing is a best viewed as a response (i.e., a coping mechanism) rather than an exposure.

What Needs More Study?

Because alcohol and drug use are highly comorbid with PTSD, empirical evidence of substance use by persons with September 11-related PTSD is needed. Preliminary evidence on this topic is mixed, with some studies indicating increase in substance use following the attacks and others indicating no increase.

Occupational Groups Needing Attention

The helping professions are at increased risk following extreme events, primarily because of higher levels of exposure to the events. For September 11, these include police and fire fighters in the affected areas, therapists working with victims, and potentially commercial airline pilots and flight attendants.

Characteristic Symptoms of PTSD

Re-experiencing symptoms-e.g., recurrent distressing dreams of the event, inability to stop thinking about the event while awake. Avoidance symptoms-e.g., conscious efforts to avoid reminders of the event, emotional numbing.
Symptoms of psychophysiological reactivity-e.g., chronically feeling "on guard," difficulty sleeping, exaggerated startle response

Treatment for PTSD

PTSD is often a chronic disorder. Several medications have been shown in randomized trials to be helpful in managing symptoms. Several approaches to psychotherapy have also been shown in randomized trials to be helpful

Additional Studies Needed

Studies of the long term course of PTSD. Studies of the effect of treatment on the course of PTSD. Studies of the effect of additional (i.e., subsequent) exposures to trauma on course of PTSD