Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center

This study examined the relationship between individual differences in adult attachment and psychological adaptation in a sample of high-exposure survivors of the terrorist attacks on the World Trade Center on September 11, 2001. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed via self-report 7 and 18 months after the attacks. In addition, friends and relatives were asked to provide evaluations of participants' adjustment before and after the attacks. Findings indicate that securely attached individuals exhibited fewer symptoms of PTSD and depression than insecurely attached individuals and were viewed by friends and relatives as showing an increase in adjustment following the attacks. Highly dismissing adults were viewed by their friends and family as showing neither increments nor decrements in adjustment, despite the fact that highly dismissing people self-reported relatively high levels of PTSD and depression.     

Posttraumatic stress disorder in the general population after mass terrorist incidents: considerations about the nature of exposure

Epidemiologically, disasters represent multiple forms of possible exposures, including exposure type (eg, natural versus human-made), intensity, and duration. It has been suggested that the consequences of human-made disasters (eg, terrorist incidents) may be more severe than those of natural disasters; recent evidence suggests that there may be a high prevalence of posttraumatic stress disorder (PTSD) among both direct survivors of such attacks and in the general population. Several studies after the September 11, 2001, terrorist attacks found that the prevalence of PTSD was higher in New York City than it was in the rest of the US and that there was a substantial burden of PTSD among persons who were not directly affected by the attacks. This raises important questions about the meaning of "exposure" to a disaster. Using data from an assessment of PTSD in the first 6 months after September 11th we considered the nature of the PTSD experienced by persons who were not directly affected by the September 11th attacks. These data suggest that persons in the general population may have clinically important posttraumatic stress symptomatology after a mass terrorist incident. Future research should consider mechanisms through which persons in the general population may be at risk for PTSD after such incidents.     

Correlates of Functional Impairment in Treatment-Seeking Survivors of Mass Terrorism

This study sought to identify variables associated with functional impairment in persons exposed to terrorism. A sample of adults who sought treatment for psychological distress related to the 2001 World Trade Center attack completed standardized self-report measures of PTSD symptoms, expectancies of ability to regulate negative moods, interpersonal problems, and social-occupational impairment. A multiple regression analysis found that PTSD numbing symptoms, beliefs about the ability to regulate negative moods, feelings of social discomfort and expectations of being disliked, income level, and relationship status significantly predicted 58% of the variance in social-occupational impairment. The results suggest that treatments targeting PTSD numbing symptoms as well as maladaptive expectations about social interactions and one’s ability to manage negative affect may have utility for persons adversely affected by mass violence.     

Studies of the vicarious traumatization of college students by the September 11th attacks: effects of proximity, exposure and connectedness

From mid-October 2001 through the end of November 2001, we collected fairly large sets of questionnaires from undergraduates at three public universities (Albany, NY, n = 507, Augusta, GA, n = 336, Fargo, ND, n = 526 ) to assess rate of acute stress disorder (ASD) and level of ASD symptoms following the September 11th attacks, rate of current posttraumatic stress disorder (PTSD) and level of PTSD symptoms, and current level of depressive symptoms resulting from the September 11th attacks. We also gathered information on exposure to media coverage of the attacks, connectedness to the World Trade Center (WTC) and personnel there, and degree of engagement in reparative acts such as giving blood, attending vigils. We found higher levels of ASD, ASD symptoms, PTSD and PTSD symptoms as a function of geographical proximity to New York City (and within the Albany site, proximity of students' homes) and gender. Exposure (hours of TV watched) was a predictor in some instances as was connectedness to WTC victims. ASD symptoms were the strongest predictor of subsequent PTSD symptoms. Path models accounted for over 60% of the variance in PTSD symptoms.     

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly exposed populations in the first 10 years after the 9/11 attacks. We performed a systematic review. Eligible studies included original reports based on the full Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; American Psychiatric Association, 2000) criteria of PTSD among highly exposed populations such as those living or working within close proximity to the World Trade Center (WTC) and the Pentagon in New York City and Washington, DC, respectively, and first responders, including rescue, cleaning, and recovery workers. The large body of research conducted after the 9/11 attacks in the past decade suggests that the burden of PTSD among persons with high exposure to 9/11 was substantial. PTSD that was 9/11-related was associated with a wide range of correlates, including sociodemographic and background factors, event exposure characteristics, loss of life of significant others, and social support factors. Few studies used longitudinal study design or clinical assessments, and no studies reported findings beyond six years post-9/11, thus hindering documentation of the long-term course of confirmed PTSD. Future directions for research are discussed.     

Posttraumatic Growth in Trauma Recollections of 9/11 Survivors: A Narrative Approach

The relationship between posttraumatic growth (PTG) and adaptation is unclear. This study is the first to examine PTG in trauma narratives of survivors of the World Trade Center (WTC) attacks. Participants recalled their experiences 7 and 18 months post 9/11, and content analysis was conducted to detect PTG. Posttraumatic stress was also measured. PTG was commonly reported. Relating to others and positivity were frequent in the PTSD and non-PTSD group, although less frequent over time in the PTSD. Greater appreciation for life was reported by the non-PTSD group but relatively absent in the PTSD group. Women but not men reported relating to others across time. It appears that there are distinct profiles of growth implicated in distress and adaptation.     

The medical student experience with disasters and disaster response

Medical students from New York City were integrally involved in the response by health professionals to aid the families of victims of the September 11, 2001, attacks on the World Trade Center. The present study was performed to investigate the emotional impact of this involvement on medical students from the Mount Sinai School of Medicine in New York City. One hundred fifty-seven students responded to a mail survey that explored their personal and professional involvement in the disaster as well as their psychiatric symptoms in the week after the event and at the time of the survey (3.5 months after the event). Findings suggested a differential emotional impact on female students and on students involved in less supervised and more emotionally intense activities. However, involvement in the relief effort, per se, did not contribute to psychiatric symptomatology. It may have been associated with enhanced professional self-esteem among the students. These findings have implications for future planning of psychiatric response to disasters.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

The Monsters in My Head: Posttraumatic Stress Disorder and the Child Survivor of Sexual Abuse

Posttraumatic stress disorder (PTSD) is 1 of several possible outcomes of child sexual victimization. There is a growing body of literature regarding the prevalence of PTSD among children who have been sexually victimized. Using specific case examples, this article looks at the nature and scope of the problem, diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) symptomatology of children presenting with this disorder, assessment and diagnosis, treatment interventions, and implications for counselors treating this population.     

Treating survivors of the World Trade Center terrorist attacks of September 11, 2001

As part of an established traumatic stress research and treatment program located in New York City, we experienced the September 11, 2001, terrorist attacks on the World Trade Center first as New Yorkers, but also as professionals with an interest in both treating the survivors and furthering scientific knowledge regarding the neurobiology and treatment of traumatic stress. This paper gives vignettes of calls to our program and the treatment of World Trade Center terrorist attack survivors.     

Rebuilding security: group therapy with children affected by September 11

This article examines group therapy with children and adolescents impacted by the September 11 terrorist attacks on the World Trade Center, with a focus on the role of metaphor, enactment, and the creative arts therapies in trauma treatment. Attention is given to the importance of fantasies, family structure, and culture in determining how the child constructs and processes the events. Examples are derived from ongoing, trauma-focused groups with traumatically bereaved children who lost parents, as well as from ongoing drama therapy groups in which traumatic themes emerged.     

Prevalence and social and health correlates of insomnia symptoms among middle-and older-age persons in rural South Africa

This study investigated the prevalence and social and health correlates of insomnia symptoms among middle-and older-adults in rural South Africa. We analysed baseline survey data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa (HAALSI) (N = 5 059; females = 53.6%; largely African Shangaan/Tsonga-speaking). In all, 8.0% of the adults had three insomnia symptoms, 8.9% of participants had difficulty initiating sleep, 13.6% had difficulty in sleep maintenance, and 6.5% had poor sleep quality. In adjusted logistic regression, lower education, perceived unsafe neighbourhood, poorer self-rated health status, vision difficulty, pain, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms increased the odds of having insomnia symptoms. Insomnia symptoms are common in middle-and older-age adults in rural South Africa, and various risk factors were identified. This can help in improving insomnia prevention treatment in this population.     

Epidemiology of trauma and posttraumatic stress disorder in Mexico

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world.     

Psychological Impact of Terrorism on Children and Families in the United States

Summary

This article reviews the literature on the psychological impact of terrorism on children and families in the United States. It includes studies of the 1993 World Trade Center bombing in New York City and the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, as well as the September 11 attacks. These studies explore the impact of various forms and degrees of exposure to terrorism on children across the development spectrum and on the relationships between parental and child reactions. The article concludes with a framework for future research on children's adaptation following mass trauma.     

Anger-associated panic attacks in Cambodian refugees with PTSD; a multiple baseline examination of clinical data

Despite the increasing recognition of the importance of anger as a key aspect of post-traumatic stress disorder (PTSD), the presence of anger-induced panic attacks has been understudied in traumatized groups. The present investigation determines the prevalence of anger-associated panic attacks among Cambodian refugees suffering from PTSD. Specific characteristics of these episodes that were examined included frequency, symptoms, and cognitions (in particular, fear of death from bodily dysfunction). In a survey of 100 Khmer patients suffering PTSD, 58% reported anger-associated panic attacks in the last month. These attacks occurred at a mean rate of 6.2 attacks a month and were characterized by extreme arousal and in 81% of these cases, fears of death due to bodily dysfunction during the anger-induced panic. Mechanisms for this high rate of fear of death during anger arousal are discussed with a focus on culture-specific catastrophic cognitions.     

Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed.     

A survey of habit behaviors exhibited by individuals with mental retardation

The purpose of this study was to investigate the prevalence and characteristics of habit behaviors exhibited by individuals with mental retardation living in the community. Two hundred and fifty-nine direct care staff and parents from the upper mid-west and northeast regions of the country completed a survey measuring the prevalence of major habit disorders (bruxism, trichotillomania, motor/vocal tics, and stuttering) and habit behaviors exhibited by individuals with mental retardation being served by community residential agencies. Habit disorders were also subjectively evaluated according to the respondents' perception of the severity and noticeability of the behavior, and naturalness of appearance of the individual. In addition, respondents indicated their usual reaction to the habit disorder. Overall, stuttering was found to be the most prevalent habit disorder (32%), followed by tics (16·6%), bruxism (13·1%), and trichotillomania (5%) for the sample surveyed. Furthermore, differences were found in the prevalence of habit disorders and other habit behaviors by level of mental retardation and age (adults versus children/adolescents). The implications and limitations of the data, as well as suggestions for future investigations of habit disorders and habit behaviors exhibited by individuals with mental retardation, are discussed. © 1998 John Wiley & Sons, Ltd.     

Loss Of Trust: Correlates Of The Comorbidity Of Ptsd and Severe Mental Illness

Abstract

The prevalence of post-traumatic stress disorder (PTSD) in the general population of the United States is a topic of speculation, with estimates ranging from 0.4% to 9% (Breslau, Davis, Andreski, & Peterson, 1991; Helzer, Robins, & McEvoy, 1987; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Likewise, estimates of the prevalence of PTSD within the population of persons with serious mental illness have varied widely, depending on how PTSD has been measured. While record verification of PTSD within mental health outpatient samples has routinely been very low (0%-3%), research assessments of PTSD have resulted in estimated rates of co-occurrence of 29% to 43% (Cascardi, Mueser, DeGirolomo, & Murrin, 1996; Craine, Henson, Colliver, & MacLean, 1998; Mueser et al., 1998). A lack of documentation of PTSD in clinical records and inattention to PTSD in clinical diagnoses are thought to greatly underestimate the extent of PTSD within mental health treatment populations. The general consensus among researchers has been that the occurrence of PTSD is much higher within the population of persons with diagnoses of mental illness than in the general population, particularly among those who have major depression (Friedman & Rosenheck, 1996).     

University Violence in Jordan: PTSD Consequences

This study aimed to investigate the relationship between witnessing university violence and developing posttraumatic stress disorder (PTSD) among university students. A total of 885 students from Hashemite University participated in the study. A self-administrated questionnaire and the PTSD Interview Schedule were distributed. The study revealed a low to moderate prevalence of PTSD symptomatology among the study sample; there were significant differences in PTSD prevalence based on faculty type, personal traumatic history, living situation, injuries resulting from university violence, students' violence involvement, and short duration of witnessing violence. There were no statistical differences in PTSD prevalence based on gender and type of degree.     

Adverse childhood experiences,religious/spiritual struggles,and mental health symptoms: examination of mediation models

Emerging research has documented greater risk for posttraumatic stress disorder (PTSD) and depression among young adults with prior adverse childhood experiences (ACEs). Building upon prior findings, we hypothesised that religious/spiritual (R/S) struggles may serve as an intervening pathway through which accumulation of ACEs impacts mental health symptom severity in this population. Young adults (N?=?458) were recruited from a southeastern university to complete an online self-report survey that assessed for ACEs, lifetime trauma exposure, R/S struggles, PTSD and depressive symptomatology. Bivariate correlations yielded significant positive relationships between ACEs and all six types of R/S struggles, depression, and PTSD. Additionally, when accounting for non-childhood trauma exposure, the mediational analyses indicated an indirect effect of struggles with ultimate meaning on the well-establish association between ACEs and mental health symptoms. Clinical implications (such as the importance of fostering meaning making), study limitations, and future research directions are discussed.