All traumatic events pose a palpable threat to safety. The defining feature of a disaster, however, is that it threatens the safety of an entire community as well as its individual members (Norwood, Ursano, & Fullerton, 2000). Disaster-related trauma affects individuals directly, by their own exposure to the event and its consequences, as well as through the community in which they live, by word of mouth, media coverage, and disruptions in services and events that make up everyday life (Galea et al., 2003). The September 11, 2001, terrorist attacks, one of the most significant disasters of the 21st century, provide a stunning example of the profound political, psychological, and economic effects that may follow a disaster. Thus, society must confront not just the needs of individuals affected by the disaster but those of the community as well. Disasters include natural environmental events, such as hurricanes, tornadoes, floods, and earthquakes, which often strike without warning and cannot be prevented (Fullerton, Ursano, Norwood, & Halloway, 2003; Norwood et al., 2000). The tsunami spawned by the Indian Ocean earthquake on December 26, 2004, is a striking example. Man-made disasters result from human actions, and include two types: intentional acts such as mass violence and terrorism and nonintentional acts such as accidents. The latter, often categorized as technological disasters, refer to failures of man-made products (Norris, 2001; Norris, et al., 2002). Examples include the accident at the Three Mile Island nuclear power plant in 1979 and the crash of Pan Am flight 759 in 1982. Further, "complex disasters" such as Hurricane Katrina in 2005, where the natural impact of the storm was exacerbated by the breakdown of the levees in New Orleans and the nation's disaster relief system, comprise both natural and man-made elements (Ericsson, n.d.). (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)

It is critical to understand how disasters and terrorist attacks affect children and how they cope with and recover from such events. The goal of this chapter is to review evidence-based approaches to treating children following these kinds of traumatic events. To set the stage for this review, the first section describes the symptoms and prevalence of PTSD in children following disasters and acts of terrorism as well as other trauma-related reactions. The second section briefly describes risk factors for posttraumatic stress reactions. The third section reviews the current state of intervention research. The chapter ends with a summary of best practices for delivering interventions in the aftermath of disasters/terrorism. [Adapted from Text, p. 122]

Background: Israeli citizens have been exposed to intense and ongoing terrorism since September 2000. We previously studied the mental health impact of terrorism on the Israeli population (Bleich et al., 2002), however the long-term impact of ongoing terrorism has not yet been examined. The present study evaluated the psychological sequelae of 44 months of terrorism in Israel, and sought to identify factors that may contribute to vulnerability and resilience. Methods: This was a telephone survey using strata sampling of 828 households, which reached a representative sample of 702 adult Israeli residents (84.8% contact rate). In total, 501 people (60.5%) agreed to participate. The methodology was similar to that of our previous study. Exposure to terrorism and other traumatic events, number of traumatic stress-related symptoms (TSRS), percentage of respondents with symptom criteria for post-traumatic stress disorder (PTSD), traumatic stress (TS) resiliency and feelings of depression, anxiety, optimism, sense of safety, and help-seeking were the main outcome measures. Results: In total, 56 participants (11.2%) were directly exposed to a terrorist incident, and 101 (20.2%) had family members or friends exposed. Respondents reported a mean ± SD of 5.0 ± 4.5 TSRS; 45 (9%) met symptom criteria for PTSD; and 72 (14.4%) were TSresilient. There were 147 participants (29.5%) who felt depressed, 50 (10.4%) felt anxious, and almost half (235; 47%) felt life-threatening danger; 48 (9.7%) felt the need for professional help. Women and people of Arab ethnicity had more TSRS, more PTSD, and less TS resiliency. Injury following a life-threatening experience, a major stressful life event, and a major loss of income were associated with PTSD. Immigrant status, lower education, low sense of safety, low sense of social support, high societal distress, and injury following life-threatening experiences were associated with TSRS. TSRS did not increase with exposure severity.

Modern Terrorism and Psychological Trauma brings together a rich collection of insightful studies by leading psychiatrists, psychologists, and other mental-health professionals, to provide readers with a deep understanding of the nature of psychological trauma induced by modern terrorism. Most fundamentally, through studies of victims of terrorism in America on 9/11 and afterward in England, Spain, Israel, and other countries--as well as studies of pre-9/11 victims, especially Holocaust survivors--this anthology clearly explains: a) The ways that mental-health professionals conceptualize and analyze the nature of terror-induced psychological trauma at both the individual and the community levels; b) why research findings on terror-related psychological trauma have profound treatment implications for men and women of every age, socioeconomic status, religion, nationality, and ethnic background; c) how psychotherapists can achieve more enduring alleviation of symptoms by conceptualizing terrorism-related symptoms on an acute versus continuous stress paradigm basis. Modern Terrorism and Psychological Trauma is more than an invaluable primer, however, because Dr. Trappier organizes the seminal literature anew based on his original theoretical perspective, which approaches the spectrum of psychological trauma as a multi-layered hybrid of events and uses a novel, multi-dimensional model to explain the entire spectrum of psychopathology related to terrorism. In its simplest form, the Trappier model posits that most victims have some stress-related symptoms following exposure to a discrete terrorist attack, while fewer victims are left with enduring symptoms of classic PTSD. The more complex form of trauma pathology evolves from a prolonged relationship between the victim and the perpetrator. Here Dr. Trappier deviates from PTSD reductionism and explores object-relations and Jungian theories to explain the insidious transformative effect of "continuous terror" on the victim

Humans show an extraordinary capacity to survive in adverse situations. Although there are tragic instances of people who are permanently scarred by trauma, these are relatively few; the majority of those who are involved in violent or life-threatening events do not exhibit long-term symptoms of distress. On the whole, they recover and may even exhibit resilience. When terrorists strike neighborhoods, what people most often do is wash the blood off the streets and continue on. How and when such recovery occurs is the theme of this chapter. Here we consider the possibility that the survival, recovery, and occasional resilience seen after terrorist incidents or other disasters reflect processes of dissipation, adaptation, habituation, and sensitization that are ubiquitous to biological organisms. We also consider that many instances of human survival -- including thriving -- are the result of broad cognitive and affective reappraisal processes that mediate the impacts of our interactions with the world and of normative tendencies to seek out others under conditions of stress. We describe the near- and long-term psychological effects of exposure to terrorist attacks and the threats of terrorist attacks here, largely ignoring important differences in location, type of strife, and local and national histories, not because these are not important but because we want to consider the most frequently occurring behaviors and the most general behavioral trends. While there is relatively little empirical analysis of terrorism or terrorists' behaviors -- despite the plethora of materials published since 9/11 -- there is a significant body of scientific investigation on how people respond to trauma. It is that domain of science that we draw on to understand and predict how people are most likely to respond to terrorist attacks. [Text, p. 175]

This reprinted article originally appeared in Current Opinion in Psychiatry, 2002, 15(6), 633-637. (The following abstract of the original article appeared in record 2004-18916-013.) Purpose of review: Terrorist attacks are increasing in different parts of the world. The psychiatric consequences of terrorist attacks, particularly post-traumatic stress disorders, are often underrated. Recent terrorist attacks, particularly the attacks of September 11, 2001 in the USA, focused attention on post-traumatic stress disorder. This review examines the prevalence rates and characteristics of post-traumatic stress disorder after terrorist attacks. Recent findings: At least 28-35% of people exposed to a terrorist attack may develop post-traumatic stress disorder. Whereas persons directly exposed to terrorist attacks have a greater risk of developing post-traumatic stress disorder, the secondary effects of vicarious exposure on people not directly exposed are significant. Individuals with post-traumatic stress disorder have higher healthcare utilization and medication use. More than 40% of people across the USA experienced substantial symptoms of stress after the attacks of September 11, 2001. The rates of acute post-traumatic stress disorder and depression among residents of lower Manhattan, New York, were twice the baseline rate 5-8 weeks after the attacks. The presence of pre-existing stressors, levels of social support, female sex, and Hispanic ethnicity were important predictors of post-traumatic stress disorder. Disaster-related television viewing could be harmful for children. The role of psychological debriefing in the prevention of post-traumatic stress disorder is questionable. Summary: Most suffers of post-traumatic stress disorder are reluctant to see mental health professionals. Primary care physicians are best suited to identify and manage individuals with posttraumatic stress disorder. There is a need to train primary care practitioners in the identification and

People exposed to a violent event such as a terrorist attack present various reactions to stress that may need an emergency intervention and first some specific traumatic stress evaluation. The latter is crucial when it comes to determine those who will develop severe and disabling troubles likely to last several years. It is demonstrated that these troubles are particularly severe when they are related to human designed traumatic events such as terrorism. 5 to 20% will develop psychiatric post-traumatic symptoms. Of all those concerned, health care professionals have to determine those for whom a severe evolution is dreaded. It is crucial to make their taking care of a priority. We will indicate the best predictive factors of a pathological evolution hereafter. We will present the most useful questionnaires and clinical characteristics to identify subjects with the higher risk of PTSD. According to these criteria a health care strategy is going to be determined. Identifying the predictive factors concerns the individual peritraumatic reactions as well as the traumatic event itself. Thus it is necessary to take into account the previous health state of the person and the early help provided. Among the initial reaction characteristics several clinical studies suggest that measuring the heart beat is an indicator to emotional reaction. A heart beat superior to 92 per minute could predict a PTSD to come. This simple physiological indicator added to more specific psychological and peritraumatic dissociation ones could be the best actual PTSD predictive factors. [Author Abstract] KEY WORDS: evaluation; dissociation; peritraumatic reaction; PTSD; questionnaire

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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(chapter)

The acquisition of chemical, biological, radiological, nuclear, and high-yield explosive (CBRNE) weapons remains a priority of several terrorist organizations. Terrorism is psychological warfare, and the civilian population is the primary target. This chapter presents several historical models that illustrate critical psychological aspects of this threat. In addition to the psychological reactions to the 9/11 attacks, we examine gas exposure in World War I, ballistic missile attacks on Tehran and Israel, a radiological accident in Brazil, an outbreak of plague in India, and a chemical attack on the Tokyo subway. We describe the potential psychological impact of various CBRNE weapons and present evidence that argues against the likelihood of mass panic in the aftermath of a CBRNE attack. We discuss the phenomenon of mass psychogenic illness and offer recommendations for treatment and planning. [Adapted from Text, p. 153]

Recent geo-political events such as the global war on terrorism and the unprecedented attacks upon the Pentagon in Washington, DC and the World Trade Center in New York City have stimulated a renewed interest in the concept of terrorism, as well as its psychological effects en masse. Due to a number of factors that seem to indicate a more war-like shift in terrorist tactics, there may be heightened risk of attacks resulting in mass death. Disaster relief workers involved specifically in body handling duties may be especially vulnerable to the psychological impact of their work in these contexts. Psychological factors operative among body handlers in the setting of terrorist attack scenarios has not received systematic study; however, there exists a literature describing experiences, vulnerability factors and health outcomes among individuals exposed to human remains in the aftermath of wartime and other disasters that may have a broad applicability even to crises associated with terrorist attacks. We begin the present review by describing "modern" terrorism and its propensity to cause mass disaster and summarizing the existing literature concerning the stress of handling human remains during disaster relief exercises. We close by attempting to tie relevant points from the literature summary to potential modern terrorist attack scenarios. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)