The objectives of this paper are to develop insights into the mind of the terrorist, to conduct a review of health impacts on the health of populations, especially from the point of view of mental health impacts caused by terrorist attacks and to discern the role to be played by forensic psychiatry in emergencies caused by terrorist actions. These objectives are developed at the population level and at the individual level from the point of view of a description of the terrorist and of victim's need for forensic intervention and representation. On entrance, the paper starts with a general frame of definitions and a historical overview of terrorism as an ancient, purposeful, political tool used to change a situation objectionable to the terrorist group via intimidation of a captive population. People are used as expendable pawns and become psychologically captive to the aims of the terrorist group. As well, the paper reviews the new reality of bioterrorism and the use of improved technologies to inflict expensive damage to national infrastructures and massive loss of life. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Exposure to a terrorist attack is a traumatic experience that may result in elevated anxiety levels (DSM-IV, 1994). Aspects of religiousness were found to be correlated with better mental health outcomes. This study assessed levels of anxiety and cognitive functioning in subjects who were exposed to terror attacks and correlated it with reported levels of religious faith. Thirty-seven participants were recruited from religious settlements in the West Bank area in Israel. Fifteen subjects had been exposed to a terrorism event without developing predict post-traumatic stress disorder and 22 controls had no such exposure. Learning and memory retrieval, for verbal and visual stimuli, were tested and the groups were compared. Half of the stimuli in each modality (verbal and visual) were rated as stressful, and half of them were rated as neutral. Responses and reaction times were recorded. Additionally, participants completed questionnaires to assess current anxiety and anxiety-proneness and reported religiousness. Memory performance was found to be significantly lower for those exposed to terror attack, in comparison with the controls. The differences were significant for visual stimuli only and in particular for the stress-related stimuli. The terrorism exposed group reported higher levels of state anxiety that was negatively correlated with levels of their reported religious faith. Although aspects of religiousness were found to be negatively correlated with current anxiety levels in the terrorism exposed group, this study did not show religious beliefs provided immunity against cognitive deterioration. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Acts of terrorism have an extremely negative impact on the mental health of children and families. The school siege in Beslan, Russia, in 2004, represents a particularly traumatizing event as it was directed specifically at children and involved the entire community. This qualitative study aims to: (a) examine caregiver reactions to the terrorist attack in Beslan as reported 3 months after the traumatic event; (b) determine the extent to which indigenous cultural values and religious belief systems play a role in Beslan's caregivers' reactions to such event; and (c) identify variables that may function as sources of resilience to caregivers. A convenience sample of 17 primary caregivers from Beslan with at least one child who survived the school siege were asked to participate in semi-structured interviews. Narratives generated from the interviews were qualitatively analyzed using a thematic approach; nine major themes were identified. Caregivers' concerns centered on children's physical and psychological well-being, the reorganization of family life, and the disruption of community ties. Cultural values of pride, heroism, courage, and revenge emerged as relevant aspects shaping caregivers' reactions to the traumatic event. Possible sources of resilience included the willingness to return to normality, social support, and the reaffirmation of positive, culturally shared values in face of the perceived threat of future terrorist attacks. Findings are discussed in terms of their theoretical implications on the effects of trauma on children and families as well as interventions with highly traumatized populations in diverse cultural settings. [Author Abstract] KEY WORDS: Beslan; terrorism; children; families; culture; Russia; resilience

This research examines psychological distress among 955 economically disadvantaged New York City residents surveyed during high school and again after the September 11th terrorist attacks (9/11), when they were young adults. As part of the longitudinal Reach for Health study, young adult surveys were conducted from 6-19 months post-9/11 (average 8 months), providing opportunity to assess types of exposures and psychological distress, including symptoms of PTSD, depression, hopelessness, and anger. Regressions of psychological distress on 9/11 exposure were performed, controlling for high school distress, prior exposure to violence victimization, and socio-demographic characteristics. Exposure to 9/11 was positively associated with anger, hopelessness, and PTSD symptoms and a measure of global distress. The relationship was greater among women for PTSD symptoms. Although those who reported high school distress also reported more distress in young adulthood, prior psychological distress did not moderate the relationship between exposure and psychological outcomes. Greater exposure is related to distress among those who, during high school, reported lower distress, as well as among those who reported prior greater distress. [Author Abstract] KEY WORDS: September 11th; terrorism; psychological distress; ethnic/racial minority; longitudinal; PTSD symptoms

In the previous editorial, complex issues on terrorism were discussed, including definitions, a general overview of terrorism and its history, as well as a description of the terrorist, and the special case of suicide-bombers. Due to the complexities of the issues and space requirements, it was left for a second editorial to deal with mental-health impacts and the role of psychiatric interventions after terrorist acts. It is my wish to discuss these matters in this editorial. No country and no peoples could be shielded from terrorist actions in our modern world. Reasons for grievances are many, and there is no country or government that could satisfy all of them, for everybody, all the time. Indiscriminate mayhem is the goal in order to inflict a sense of panic in the population, to bring governments to action or to defeat, or to destroy whole societies and way of life by those who see only their way as the right way. The possibility of bioterrorism makes it urgent for all countries to coordinate efforts for its containment, and for each country to organize health systems that could act at once in the face of attacks. Terrorist actions infringe on the human rights of populations, most specifically, on the right to life and the right to health. Indiscriminate terrorist mayhem could be categorized as a war crime and, as anybody could be affected, all countries should have a responsibility to prevent these acts and to bring the perpetrators to justice. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

This study examined adolescents' adjustment following the attacks of September 11, 2001 (9/11). A Web-based survey was administered 2 weeks and 7 months postattacks to a national sample of adolescents (N = 104). A randomly selected parent also completed a survey at the 7-month assessment. Although exposure to the attacks was indirect, over half the participants felt threatened. Adolescents' posttraumatic stress symptoms were associated with their acute stress symptoms, parental distress, parental coping advice, parental availability to discuss the attacks, and reports that 9/11-related discussions were unhelpful. Adolescents' distress symptoms were associated with a history of mental health problems, acute stress symptoms, and parental unavailability to discuss the attacks. [Author Abstract]

Objective: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast. Method: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments. Results: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects. Conclusions: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

After the Madrid March 11, 2004 terrorist attacks, the interplay of politicians, journalists, and academicians created an atmosphere of collective trauma. The authors analysed data related to these attacks in a sample of the population of Madrid (N = 503) 18-25 days after the attacks. PTSD was systematically assessed on the basis of a self-administered interview. The data, however, shows that there is no scientific evidence at all for collective traumatization, or an epidemic of PTSD. The incidence of PTSD ranged from what can be expected as a normal prevalence in general population in Spain under non-traumatic conditions to values that, when applied to the general population, could be considered a dramatic epidemic of PTSD. These results demonstrate that inferences about the impact of traumatic events on the general population largely depend on the measure, definition, and criteria used by the researcher. Slightly changing the criteria for PTSD makes an enormous difference to the amount of traumatization that is found. This may help to explain divergent and conflicting messages coming from the so-called population-based epidemiological studies on PTSD. The implications for public health policies related to collective traumatic events are discussed in relation to these results. [Author Abstract] KEY WORDS: PTSD; PTSD Checklist - Civilian version (PCL-C); acute stress disorder; risk factors; stress; terrorism

Objective: To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland. Design: Randomised controlled trial. Setting: Community treatment centre, Northern Ireland. Participants: 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict. Interventions: Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter. Main outcome measures: Primary outcome measures were patients' scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale. Results: At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group. Conclusion: Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

Purpose of review: This article aims to review and summarize the recent literature investigating the relationship between posttraumatic stress disorder and terrorism. A particular focus is given to the studies related to the terrorist attacks on New York City and Washington, DC on 11 September 2001. The review aims to provide an update on an article published in this journal in the year following the September 11 attacks. Recent findings: Elevated rates of posttraumatic stress disorder in the general population follow terrorist attacks but soon normalize, whereas directly exposed populations have higher rates and more persistent symptoms. An increased risk of posttraumatic stress disorder is associated with direct exposure, geographical proximity, female sex, low income, poor education, poor social supports and prior psychotropic drug use, and high-level media reporting of events (for vulnerable individuals). Summary: An accumulating body of data exists on the relationship between posttraumatic stress disorder and terrorism in recent years. Caution needs to be exercised in drawing general conclusions as numerous variables need to be taken into account in addition to the socio-political context of the terrorist attacks. Having said this, a number of consistent findings are emphasized, not least the high degree of psychological resilience demonstrated across populations affected by terrorism. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)