Just watching television footage of the terrorist attacks of September 11, 2001, was enough to cause clinically diagnosable stress responses in some people who did not even live near the attacks—let alone the millions of people who did.
Like many other major disasters, 9/11 brought with it a host of psychological repercussions, one of the most severe of which has been post-traumatic stress disorder. PTSD is characterized by trouble sleeping, difficulty controlling anger, losing interest in activities, flashbacks, emotional numbness and/or other symptoms. If not treated, it can be debilitating.
But these reactions are not uncommon after a major disaster—and teasing apart post-9/11 disorders has been tricky for psychologists and researchers. "We tend to use the terminology of PTSD very loosely. A lot of people will have traumatic reactions but not necessarily PTSD," says Priscilla Dass-Brailsford of Georgetown University Medical Center's psychiatry department.
Researchers have been poring over the piecemeal collection of studies conducted over the past decade on the conditions of people after the attacks—how they felt and how well various treatments, and the passage of time, have helped them overcome mental afflictions. And from the literature, we are learning that old styles of early intervention, such as debriefing sessions, are not as effective as once thought—and that more often than not, people are incredibly resilient and can recover on their own and should be given the opportunity to do so.
"Research on 9/11-related PTSD has challenged the ways in which mental health researchers assess exposure to trauma," Yuval Neria, of Columbia University's psychiatry and epidemiology departments, and his colleagues wrote in a new paper published in the September issue of American Psychologist. Those in the mental health field have also borrowed research from other traumatic events to better understand the psychological wounds inflicted by the terrorist attacks. "Despite the fact that the exposure is different, the symptoms and problems are more similar than some people think," Neria says of PTSD sufferers from natural disasters or combat.
The exception, not the rule
During the week after the September 11 attacks, Dass-Brailsford was on one of the first trains to New York City, where she conducted debriefing sessions with a large financial company that had had offices in the World Trade Center. Many of the workers she spoke with in those sessions "were really traumatized," especially those who had been the last persons that friends or colleagues had spoken to before they perished.
But not everyone who was at the scene of any of the attacks on the morning of September 11 wound up suffering from PTSD or an other severe stress response. In fact, the majority did not. After traumatic events, such as 9/11 or Hurricane Katrina, "people expect the survivors or the victims to have PTSD, but that's not necessarily the case," says Dass-Brailsford, who also worked as a psychiatric first responder in the week after Katrina. Even if people experience occasional anxiety or stress having "perfectly normal reactions," she explains.