Mental Health Aspects of Terrorism:
Understanding, Intervening, Recovering, Rebuilding
Whether this is your first year attending college or you are a
seasoned upper-classman, dealing with a traumatic event, such as the
terrorist attacks that took place on September 11, the subsequent
anthrax attacks, and the war in Iraq, when you are away from your
family can be difficult. Even if you were not directly affected by
these events, no one who sees a disaster like what happened on
September 11th, 2001 firsthand or in the media is untouched by it. It
is normal for you to feel anxious about your own personal safety as
well as stress and grief about what has happened. Remember that you
are not alone in having these feelings and that people across the
country as well as many fellow students on your campus have been
emotionally affected by these events.
However, understandably, some people will experience emotional and
behavioral problems after a disaster such as a terrorist attack or
feel anxious during the period when our country was at war. Their
responses may be similar to those experienced after other traumatic
events such as earthquakes, floods, tornados, and severe
accidents. But there are also unique features to trauma after
terrorismñ including prolonged media exposure to the event and
uncertainty about possible recurrences of attacks.
Who is affected?
Most people ñ both children and adults ñ who witness, are
exposed to, or survive a disaster such as a terrorist attack
experience normal stress reactions for several days or weeks.
However, because of continuous exposure in the media and the
uncertainty that surrounds terrorism concerning possible additional
attacks, stress reactions may persist for a longer period.
Such experiences cause a wide range of emotions, but can also serve to
unite people, families and college campuses. Just remember that there
is not one standard pattern of reaction to terrorism and other
disasters and that different people express their emotions at
different times in different ways.
Typical Reactions:
* Emotional reactions: temporary, but at times intense, feelings
(i.e., for several days to a couple of weeks) of shock, fear, grief,
anger, resentment, guilt, shame, helplessness, anxiety, panic,
hopelessness, emotional numbness (difficulty feeling love and
intimacy, or in taking interest and pleasure in day-to-day activities)
* Cognitive reactions: confusion, disorientation, indecisiveness,
worry, sweating, shortened attention span, difficulty concentrating,
memory loss, unwanted memories, self-blame * Physical reactions:
tension, fatigue, edginess, difficulty sleeping, crying, bodily aches
or pain, being startled easily, headaches, racing heartbeat, nausea,
change in appetite, change in sex drive * Interpersonal reactions in
relationships at school, work, in friendships, or in relationships
with loved ones, such as: distrust, irritability, conflict,
withdrawal, isolation, feeling rejected or abandoned, being distant,
judgmental, or over-controlling.
However, as many as 10-30% of people who have directly experienced the
trauma of the terrorist attacks may develop post-traumatic stress
disorder (PTSD) or another type of anxiety disorder such as panic
disorder and phobias. Others may develop clinical depression.
However, simply watching the events on television would rarely be
sufficient to cause PTSD.
It is more likely that some people may develop acute stress disorder
(ASD), which is essentially a less-protracted form of PTSD. ASD tends
to be time-limited: It surfaces within four weeks of a traumatic
event, and its symptoms ñ feelings of numbness or terror, intrusive
thoughts, persuasive anxiety, vivid nightmares ñ last less than a
month. The symptoms of PTSD can occur any time after a trauma, but it
lasts considerably longer, in some cases for years, and its symptoms
tend to be more severe.
Those without a personal connection to last weekís attack may find the
return to relative normalcy more difficult if they have a preexisting
psychological disorder. That is particularly true if the problem is
an anxiety disorder or if they have survived a trauma such as a plane
crash, fire or rape. Those who were feeling vulnerable at the time of
last weekís catastrophe may also be prone to problems.
For people who are socially isolated ñ those who have no one to
commiserate with and no sense of belonging to a larger community ñ
the devastation can loom even larger. Mental health professionals say
it is particularly important for these people to try and be with other
people ñ for example, to attend a discussion group, community
meeting, religious service or other gathering.
Symptoms of ASD include:
* Dissociation (feeling completely unreal or outside yourself, like in
a dream; having "blank" periods of time you cannot remember) *
Intrusive re-experiencing (terrifying memories, nightmares, or
flashbacks) * Extreme attempts to avoid disturbing memories (such as
through substance use) * Extreme emotional numbing (completely unable
to feel emotion, as if utterly empty) * Hyperarousal (panic attacks;
rage; extreme irritability; intense agitation) * Severe anxiety
(paralyzing worry, extreme helplessness, compulsions or obsessions) *
Phobias, for example, about flying in planes or being in tall
buildings * Severe depression (complete loss of hope, self-worth,
motivation, or purpose in life)
Panic attacks and disorder as well as phobias ñ for example, a
person may be afraid to fly in planes again or to go inside tall
buildings ñ may develop after experiencing a disaster such as a
terrorist attack. In panic attacks, brief episodes of intense fear
are accompanied by multiple physical symptoms, which may include:
* Heart palpitations * Dizziness * Chest pains * Chills * Terror * A
sense of unreality * Fear of losing control * Fear of dying
People who develop panic attacks and phobias will tend to avoid
situations that they fear will trigger a panic attack, and their lives
may be increasingly limited as a result. Their work may suffer because
they can't travel or get to work on time. Relationships may be
strained or marred by conflict as panic attacks and/or phobias, or the
fear of them, rule the affected person and those close to them.
Additionally, disaster stress such as after a terrorist attack may
revive memories of prior trauma, as well as possibly intensifying
pre-existing social, economic, spiritual, psychological, or medical
problems.
What factors increase the risk of vulnerability for persistent
emotional problems?
People are at greatest risk for severe stress symptoms and more severe
problems if any of the following are either directly experienced or
witnessed during or after the disaster:
* Life threatening danger or physical harm (especially to children) *
Exposure to gruesome death, bodily injury, or bodies * Extreme
environmental or human violence or destruction * Loss of home, valued
possessions, neighborhood, or community * Loss of communication
with/support from close relationships * Intense emotional demands
(such as faced by rescue personnel or caregivers) * Extreme fatigue,
weather exposure, hunger, or sleep deprivation * Extended exposure to
danger, loss, emotional/physical strain * Exposure to toxic
contamination (such as gas or fumes, dust, chemicals, radioactivity)
Studies also show that some individuals have a higher than typical
risk for severe stress symptoms and post-traumatic stress disorder
(PTSD), who have a history of:
* Exposure to other traumas (such as severe accidents, abuse, assault,
combat, rescue work) * Chronic medical illness or psychological
disorders * Chronic poverty, homelessness, unemployment, or
discrimination * Recent or subsequent major life stressors or
emotional strain (such as single parenting)
Why are some people more resilient after tragedies?
While it is not completely understood why some people are more
resilient after a tragedy than others, there are some common threads
that emerge, including:
* Optimism * Flexibility ñ being more able to ìroll with the
punches.î Those who require control and predictability in their
lives may feel suddenly very vulnerable to the chaos. * A notion of
the ìself-narrativeî ñ an ability to see and direct
themselves helps people weather the powerful currents of emotion that
follow tragedy. * The willingness and ability to talk about the
traumatic experience and the feelings it provokes ñ the capacity to
articulate your feelings to family members, close friends, colleagues,
or mental health professionals is an important ingredient of
resiliency. The resilient also tend to have an ability to express and
navigate the wide swing of emotions that often follow trauma, horror,
or death. * A strong social support system * A belief in something
larger then oneself ñ turning to prayer or meditation for comfort
helps many people. The act of accepting that people are part of a
universe that extends well beyond their personal lives and concerns
may help foster resiliency in the face of adversity.
Tips to help you, your friends and your campus
Here are some steps to help you cope and rebuild: * Give yourself time
to heal. Be patient with your emotional state. * Remember that you
have overcome adversity and trauma in the past. Try to remember what
you did that helped you overcome the fear and helplessness in that
situation. * Ask for support from people who care about you and who
will listen and empathize with your situation. * Communicate your
experience in ways that are comfortable for you. Good ways to do this
include talking to friends and family or keeping a journal. * Engage
in healthy behaviors to help yourself cope with the stress. Eating
well-balanced meals and engaging in physical activity are all healthy
ways to cope with your emotions. * Get plenty of sleep. Loss of sleep
makes you feel tired and can increase feelings of anxiety and
depression. * Limit alcohol and caffeine consumptionóalcohol can
impair judgment and sleep; caffeine may increase feelings of anxiety *
Listen to others as they tell their stories, so that you and they can
release the stress a little bit at a time in disaster's wake. *
Connect with your faith-based organization. * Identify key resources
such as the U.S. Department of Health and Human Services, FEMA, the
Red Cross, the Salvation Army, or the local and state health
departments for more information about these issues, what you can do
to help and for services regarding clean-up, health, housing, and
basic emergency assistance. * Find out about support groups in your
area and on campus for people who have suffered from traumatic events.
Make sure, though, that the group leaders are trained professionals
experienced in providing therapy to survivors of traumatic events. *
Avoid major life decisions like changing your major since thinking
about big changes will only increase stress levels. * Conduct your
own research on what to expect after suffering a trauma.
Understanding what may happen will help you feel more in control over
your situation. * Organize meetings where you and other students can
discuss what has happened and share your feelings and fears. Talking
with each other will help the healing process. * Involve yourself in
activities to help:
* Display the U.S. flag and/or wear a red, white, and blue ribbon. *
Contribute or raise funds to support organizations that are assisting
in disaster relief and are providing help to survivors and their
families and to the families of our nationís servicemen and
servicewomen. * Give blood: Call The Red Cross at 1-800-448-3543 *
Let the government know if you have any information regarding the
terrorist attacks by visiting the FBIís website at
http://www.ifccfbi.gov or call the U.S. Department of Justice at
1-800-483-5137.
Remember that much of your life is the same. Itís OK to enjoy life and
activities even though these tragedies have occurred.
When to Get Professional Help
Short-term psychological symptoms such as feelings of overwhelming
sadness, sleep disturbances, anxiety, anger or trouble concentrating
are normal for up to a few weeks. But if symptoms persist that
interfere with your schoolwork or relationships with others, seek help
and visit your campus health or counseling center. Developing skills
to cope effectively with the feelings, thoughts and behaviors you are
experiencing is integral to the recovery process.
Keep in mind that while you will always remember what has happened,
the painful feelings will decrease over time for most of us. And in
learning to cope with these kinds of stressors, you can become a stronger, more
adaptable woman who is more connected to family, friends and her
campus community.
OTHER RESOURCES
The U.S. Department of Health and Human Services Responds to the
Mental Health Needs of the Nation
http://www.hhs.gov/news/press/2001pres/20010913.html and
http://www.hhs.gov/hottopics/healing/facts.html or call
1-800-789-22647 for more information about mental health or local
mental health services.
National Center for Post-Traumatic Stress Disorder, Department of
Veterans Affairs http://www.ncptsd.org
Managing the traumatic stress of terrorism
http://www.ncptsd.org/disaster.html
Disaster Mental Health Services
http://www.mentalhealth.org/cmhs/EmergencyServices/index.htm
Federal Emergency Management Agencyís disaster assistance
registration: 1-800-462-9029.
APA Help Center http://helping.apa.org/therapy/traumaticstress.html
Terrorism and Children
http://www.ncptsd.org/facts/disasters/fs_children_disaster.html
For parents on how to talk to kids about terrorism
http://www.sesameworkshop.org/parents/advice/article/0,4125,49560,00.html
Advice on how to talk to children
http://www.fema.gov/nwz01/nwz01_99.htm
Disaster aid available to victims of terrorist attacks
http://www.fema.gov/diz01/d1391n02.htm
Effects of traumatic stress in a disaster situation
http://www.ncptsd.org/facts/disasters/fs_effects_disaster.html
Self-care and self-help following disasters
http://www.ncptsd.org/facts/disasters/fs_self_care_disaster.html
Important phone numbers for seeking information or making donations
http://www.fema.gov/nwz01/nwz01-101.htm
Informational Phone numbers http://www.fema.gov/diz01/d1391n03.htm
The terrorism research center http://www.terrorism.com
Crisis fact sheet: 10 ways to recognize post-traumatic stress disorder
http://www.counseling.org/consumers_media/facts_ptsd10ways.htm
Facts about Post-Traumatic Stress Disorder
http://www.nimh.nih.gov/anxiety/ptsdfacts.cfm
Depression http://www.nimh.nih.gov/publicat/depression.cfm
Facts about Anxiety Disorders
http://www.nimh.nih.gov/anxiety/adfacts.cfm
Facts about Phobias
http://www.nimh.nih.gov/anxiety/anxiety/phobia/phqfax.htm
This fact sheet was prepared by Susan J. Blumenthal, M.D.,
U.S. Assistant Surgeon General, U.S. Department of Health and Humans
Services. Jessica Kagen and Lauren Marsillio provided assistance. It
includes information adapted from materials prepared by the National
Center for Post-Traumatic Stress Disorder of the U.S. Veterans
Administration, the Federal Emergency Management Agency, the American
Psychological Association Help Center, American Psychiatric
Association, The Washington Post and other resources cited in the
reference section.
