Physicians and mental health professionals involved in disaster/terrorism response planning should understand the importance of considering behavioral symptoms among trauma victims within the context of concurrent medical-surgical assessment and treatment. In addition, having medical or surgical injuries or conditions following a disaster or terrorist attack increases the likelihood a psychiatric condition is also present. This chapter will identify how postdisaster patient triage can incorporate behavioral/psychiatric assessment, merging behavioral and medical approaches in considering differential diagnosis of common psychiatric syndromes among medical-surgical disaster or terrorism casualties. [Text, p. 107]

This chapter first considers the challenges that terrorism poses to mental health, as well as the deficiencies and strengths in the mental health system that were highlighted by the terrorist acts of 2001. Later, this chapter offers a preliminary list of recommendatons for future terrorist acts and threats. [Adapted from Text]

This chapter addresses the [question as to] what clinicians may do within the traditional context of therapist-client encounter. It does not address other functions that clinicians may have, such becoming consultants to community leaders, or appearing in the media as risk communicators. In order to remain focused, this chapter emphasizes the effect of an ongoing trauma, and does not extend to reactivation of prior experiences or mental disorders. Traumatic grief is another overlapping area which clearly deserves to be fully developed elsewhere. Finally, we do not address the treatment of prolonged mental disorders, but rather those distressful and disabling conditions that occur during or immediately after disasters. [Text, p. 164]

By and large, researchers have neglected to examine the impact of terrorism on children, which makes it very difficult indeed to draw on any lessons that have already been learned. Having said this, however, there are other areas of psychosocial development that it is possible to draw from when discussing the impact of terrorism on children. One is the substantial body of research on child abuse, of various forms, as this gives a good indication of the consequences of trauma. Researchers have isolated many effects of child abuse, and importantly it has been noted that different forms of abuse (sexual, physical, emotional) can result in some of the same responses in the victims (such as aggression, antisocial behaviour, and post-traumatic stress reactions). Additionally, researchers have found similar responses in children who are witness to abuse as those who are direct victims. If it is possible to isolate potential effects of being exposed to the trauma of abuse, then it may be possible that these same responses will be noted in children and young people who have been exposed to other types of trauma, such as a terrorist attack. It is also possible to learn from the literature on loss and separation, as this gives an indication on how children will respond to loss of life in a terrorist event. This is something that is elaborated on later in this chapter. Finally, there is a growing body of research on more general responses to war conditions, and this helps to understand how children exposed to chronic situations of violence behave, particularly when the war situations are those that are most likely to include terrorist tactics or events. While there are inherent difficulties associated with comparing and contrasting studies that use different methodologies with varying degrees of reliability and validity, at present the knowledge base is not extensive enough to be very selective. This chapter discusses findings and debate in the field rather more as a means of s

Terrorism involves the illegal use or threatened use of violence, is intended to coerce societies or governments by inducing fear in their populations, and typically involves ideological and political motives. The attacks on September 11, 2001, have made Americans acutely aware of the devastation of terrorism. As the nation engages in the "war on terrorism", the psychological health of the public must not be neglected. Terrorism, whether in the form of a mass physical attack or a chemical, biological, radiological, or nuclear event, can be psychologically devastating. Psychological consequences include an array of emotional, behavioral, and cognitive reactions. People may experience insomnia, fear, anxiety, vulnerability, anger, increased alcohol consumption, or smoking, and a minority will develop psychiatric illnesses such as PTSD or depression. The number of people affected and the severity of consequences will vary according to the type and intensity of the event. The broad nature of these consequences demands a full public health response. The nation's mental health, public health, medical, and emergency response systems currently are not able to meet the psychological needs that result from terrorism. Gaps exist in the coordination of agencies and services, training and supervision of professionals, public communication and dissemination of information, financing, and knowledge- and evidence-based services. Management of the psychological consequences of terrorism will require a range of interventions at multiple levels involving a variety of service providers. Interventions are needed for the pre-event, event, and post-event phases of a terrorist attack and will have to address affected individuals and populations, the broader social environment, and the terrorists who seek to harm. The committee offers an example for a public health strategy that may serve as a base from which plans to prevent and respond to the psychological consequences of a variety of ter

We have long argued for a role for psychology in informing public policy on the grounds that psychology has much to offer on a range of social matters, including terrorism. Given the psychological nature of terrorism, it is clear that psychology has a major role to play in the national effort to counteract it. The American Psychological Association (APA) has been very active in responding to the terrorist attacks of September 11, 2001. In this chapter we discuss APA's efforts to address the threat and the impact of terrorism. We also consider a response to disaster, and we review what the literature has to say about promoting resilience in response to terrorism. [Text, p. 266]

The aim of this workshop was to explore the possibility that reactions to terrorism and terrorist events can be understood -- at least in some significant part -- within the framework of psychoanalytic theory and psychoanalytically informed practice. Thinking in this professional mode may help clinicians to maintain their unique identity and to offer their special services in times that in the past we would have thought unthinkable. [Text, p. 146]

TOPICS TREATED: Definition; Factors influencing media coverage; The role and responsibility of the media in reporting terrorist acts (trends in terrorism linked to the media); the media and victims (direct victims; secondary victims; indirect victims; the media's role in victimisation; imitation); Clinical implications and future directions (the impact of media coverage; clinical implications; future directions and research).

This chapter discusses two categories of hazardous events that lead to crisis responses in adults and children, and which most often come to mind when we think of crises in the school. We examine reactions to natural and man-made disasters, such as hurricanes, floods, and fires, and we discuss reactions to terrorist attacks or other acts of violence that may occur at school. We view such incidents as drive-by shootings, sniper attacks, and bombings as acts of terrorism. All of these events are likely to cause traumatic stress. [Text, p. 249]

This chapter examines issues related to helping children cope with the effects of terrorist violence. We begin with a review of the emerging literature reporting the effects of exposure to terrorism. Next we summarize our work involving the impact on children of the Oklahoma City bombing. This discussion is followed by a review of recent intervention efforts, the challenges in implementing such programs, and the recommendations regarding future intervention program development. Last, because the reality of terrorism in America is a relatively new phenomenon and terrorist actions toward Americans are increasing, implications for public policy are addressed. [Text, p. 328]