On September 11th, American life changed. But most of us are still not sure what it changed into. As our definition of normal continues to evolve, though, one thing is clear: Americans are more anxious than ever. Before the terrorist attacks on the World Trade Center and the Pentagon, anxiety-related disorders cost the U.S. an estimated $42 billion a year in medical and work-related losses. Now mental health professionals can only make educated estimates of how many more of us will be affected in the near future, although they have begun studying the problem.
What the experts do know is that those most at risk—specifically for developing post-traumatic stress disorder (PTSD)—are people with direct, personal involvement in the tragedies. This high-risk group includes not only individuals exposed to life-threatening danger themselves but also those who watched the events unfold from a nearby vantage point or lost a loved one. PTSD typically manifests itself in flashbacks or nightmares that replay the traumatic event, an avoidance of reminders of the ordeal or a hyperalert state. For diagnosis, symptoms must persist for more than one month but they may surface immediately.
"Those who are going to go on to the acute and chronic forms of PTSD are very likely to exhibit symptoms in the hours to days after [the event]," says Charles Marmar, professor and vice chair of the department of psychiatry at the University of California at San Francisco and associate chief of staff at the San Francisco Veterans Affairs Medical Center. Marmar estimates that between 70,000 to 100,000 people in New York alone had the kind of exposure on September 11th that puts them at risk for developing PTSD.
The count is so high in part due to the nature of the attacks. Studies show that rates of PTSD are greater following events caused by deliberate violence than after natural disasters. "If an airplane had accidentally flown off course in a heavy fog in New York and taken down one of the towers," Marmar explains, "it would have been very traumatic but probably less traumatic than knowing that somebody, or some group, wanted to kill everybody in those buildings." It is this relationship to violence that may explain the higher rates of PTSD observed in women. Compared with men, women are more likely to suffer trauma after a physical or sexual assault.
Although PTSD is the most severe reaction to a traumatic event, countless people—including many far from New York or Washington, D.C., on September 11th—have experienced heightened anxiety during the past two months. As unwelcome as their fear might be, most of it is entirely natural. The human nervous system has, over time, developed an array of stress reactions—among them, adrenaline rushes, increased respiration and greater blood flow to major muscle groups—to ensure our survival in dangerous situations. Now people in no immediate mortal danger, with nothing to fight or flee, are feeling these reactions first hand in response to a series of extraordinary events.
Individuals with previously diagnosed panic or anxiety disorders are likely to suffer from more frequent attacks and magnified symptoms, according to Lorna Wienstock, a psychotherapist who specializes in the treatment of anxiety-related disorders. But, she says, "many people are walking around in a state of generalized anxiety. People feel a sense of dread and apprehension. They feel more vulnerable." For most, such feelings are normal, but clinicians can not define what exactly constitutes a normal reaction because no two people are alike. Experts suggest that trying to return to some semblance of ordinary daily life is vital.