OBJECTIVE: This study attempted to identify remembered reactions of Oklahoma City residents at the time of the April 1995 terrorist bombing that predicted later development of posttraumatic stress symptoms. METHODS: 86 adults who sought help for distress related to the bombing 6 months after it occurred completed a survey about demographic characteristics, level of exposure to the event, symptoms of grief, retrospective reports of reaction at the time of the trauma, current posttraumatic stress symptoms, and coping strategies. To identify immediate bombing reactions predictive of later distress, retrospective reports of reactions to the trauma were correlated with current posttraumatic stress symptoms. Multiple regression analysis was used to determine which reactions predicted the emergence of posttraumatic stress symptoms. RESULTS: Reactions of being nervous and being upset by how other people acted when the bombing occurred accounted for about one-third of the total variation in posttraumatic stress symptom scores and thus were major predictors of posttraumatic stress. CONCLUSIONS: These results differ from those of other studies in which peritraumatic dissociation, or dissociation at the time of the event, was more predictive than anxiety for developing later distress. The results suggest that persons who experience significant anxiety at the time of the traumatic event may continue to experience distress. Those who are overly concerned about others' actions may be showing diminished interpersonal trust, evidence of terrorism's ability to erode social harmony. [Author Abstract]

The bombing in Oklahoma City shook the entire nation from "sea to shining sea." This tremendous collective sensation was made even worse when available evidence revealed that this act of terrorism had not been committed by some terrorist from the Middle East but one from Middle America. The blast stunned the nation's sense of collective safety, while it raised serious questions about our ability as a nation to manage violence, and the profound feelings of discontent and narcissistic injuries among distressed Americans. Was it this failure to address chronic discontents that led to this tragedy of mass violence? These larger sociocultural and political issues are being debated in public and private forums throughout the nation, an activity that is likely to continue for some time to come. As these issues are debated in the public arena, victims' levels of psychological distress are expected to rise, as they attempt to process the traumatic shock in their minds and bodies. Specifically, this article has 2 parts and focuses on acute and post-acute psychophysiological traumatic stress responses in victims, as well as issues pertaining to assessment, prevention, and treatment. Part I addresses the nature of disasters, with a special emphasis on the victim's subjective evaluation (meaning) of the reality of a catastrophe caused by intentional human strategy. The article, additionally, discusses issues of epidemiology of stress reactions, PTSD, co-morbidity, risk factors, and assessment and diagnostic considerations. Part II, to be published in the next of issue of the Journal, will focus on issues of prevention as well as post-disaster intervention. Prevention of chronic PTSD after the Oklahoma City bombing is a critical objective by debriefers and mental health professionals. A proposed four-phase model called "self-efficacy adaptational coping" will be presented in Phase II as well. [Adapted from Author Abstract]

Part II of the present contribution focuses on issues of prevention and post-traumatic disaster intervention. Prevention of chronic PTSD after the Oklahoma City bombing is a critical objective by debriefers and mental health providers engaged in victim assistance programs. A detailed description of a four-phase developmental stress recovery model is advanced. This is an interactive intervention model that integrates a wide-range of techniques from cognitive, behavioral, psychodynamic, and existential orientations, as well as pharmacology. The model is referred to here as the self-efficacy adaptational coping (SEAC) model: it orients the provider and victim toward an emphasis on personal control and competence by managing early the effects of dissociation. The proposed interventions of this model derive from the author's experience with the pervasive and persistent effects of traumatic encounters on the lives of victims/survivors -- of war veterans, inner city children exposed to family and community violence, and of natural and human-engineered disasters. [Adapted from Author Abstract]

This article reviews literature pertaining directly to responses to man-made disasters, with specific emphasis on emotional responses to terrorism. The effects of the bombing of the World Trade Center on its survivors and on the wider community are summarized. Examples of mental health outreach efforts and case vignettes of brief cognitive behavioral therapeutic intervention with survivors are provided. A postscript gives some follow-up observations in the aftermath of the federal building bombing in Oklahoma City, Oklahoma. [Author Abstract]

106 survivors of three disasters [a plane crash into a hotel (N = 46), a shooting spree (N = 18), and a tornado (N = 42)] were interviewed in the acute postdisaster period (within 4 to 6 weeks). Equivalent data were systematically collected at all three disaster sites and merged for analysis to identify risk factors for acute symptoms of PTSD. The combined analysis revealed that the number of PTSD symptoms was predicted by association with the plane-hotel crash, direct exposure to the disaster agent, and number of predisaster psychiatric diagnoses. Number of predisaster psychiatric diagnoses, however, was predictive only for the indirectly exposed group, suggesting that the intensity of exposure to a disaster agent may overpower the effects of pre-existing psychopathology in prediction of acute postdisaster PTSD symptoms. Clinical implications of the findings are that precious resources in the early postdisaster phase will be most efficiently targeted for those with the greatest exposure. Among those indirectly exposed, a history of past psychiatric problems may hurt those at risk for problems. Qualitative experiences of terror and horror did not aid in the prediction of post-traumatic distress. This analysis demonstrates the usefulness of combining data sets to identify predictors of PTSD symptoms not evident in individual analyses that are limited by small numbers, lack of variation and confounds. Combined analyses of standardized data in cross-disaster studies can overcome many of the limitations inherent in studies of single disaster events. [Author Abstract]

This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming compensation from the insurers of the airline. Claimants were examined 10 to 14 months after the disaster by clinical interview and questionnaires. The most frequent diagnoses were PTSD and depression, followed by other anxiety disorders. Many were above "caseness" levels on questionnaires, and had very high scores on intrusion and avoidance. There were no significant predictors of the presence or severity of diagnosis, but a number of predictors (age, death of friends, exposure to unpleasant sights) of questionnaire scores. [Author Abstract] KEY WORDS: disaster; PTSD; DSM-III-R; depression.

The medical and psychological consequences of terrorism were assessed through an epidemiologic survey of 254 survivors of terrorist attacks (TA) that occurred in public places in France between 1982 and 1987 (20 bombings and 1 machine-gun attack). Physical lesions were typical of bombings (blast syndrome, burn, coma), but amputations were rare. PTSD was present in 10.5% of uninjured victims, 8.3% of moderately injured and 30.7% of severely injured ones. Major depression was found in 13.3% of all victims, with no difference according to the level of the injury. Prevalence rates were not different in males and females, nor did they vary with age of the victim. The prevalence of PTSD was not associated with the delay between TA and questionnaire completion. These findings suggest the need for including psychiatric assistance in the initial care of TA victims, especially severely injured ones. [Author Abstract] KEY WORDS: terrorism; violence; injury epidemiology; PTSD; depression.

This paper has examined and compared the psychological impact of both state and anti-state terrorism on the victim. In this regard, three dimensions to this issue were discussed: (a) the effects that are common to anti-state terror and state-terror; (b) the effects that are unique to anti-state terror; and (c) the psychological effects and sequelae specifically associated with state-terror. Given the paucity of empirical research together with the complexity of the subject matter, definitive statements are difficult to advance. Despite this, however, a number of tentative conclusions can be made. With respect to psychological reactions during the incident, many similarities seem to hold for victims of a hostage-taking, concentration camps, and torture. That is, the incident begins with a period of initial shock accompanied by extreme fear and anxiety. This is followed by a phase characterized by outward acceptance of the perpetrator's control while inside the victim is experiencing extreme fright. Gradually, a period of adaptation sets in, whereby the victim may resort to a number of coping strategies. Although similarities continue after the incident--the post-traumatic stress syndrome, for example--the intensity and duration of psychological sequelae appear to be much greater in victims of state-terror. Given the extreme brutality that invariably accompanies state-terror, this is not surprising. While the methods of anti-state terrorists may take a number of different forms, usually their resources and techniques are limited in comparison to state-terror. It is only more recently in the Middle East that anti-state terrorists more routinely are engaging in long-term detention and torture of victims. On the other hand, regimes that employ state-terror have a wide range of violent techniques at their disposal, most importantly concentration camps. It appears that prolonged physical and emotional violence combined with little hope of relief or escape is critical to un

For 18 years, Northern Ireland has suffered a changing pattern of civil disorder. Early years were marked by widespread sectarian rioting, shootings, and bombings, which heightened community tension and caused much social and commercial disruption. However, in recent years, terrorist organisations have been more selective in their acts of violence. There are methodological difficulties in assessing the psychological impact of civil disorder and terrorism. But, as well as can be judged from community surveys, hospital admissions and referral data, psychotropic drug usage, suicide and attempted suicide rates, and from assessment of the actual victims of violence, society has not 'broken down' nor has the impact been judged considerable. Possible explanations are discussed.