The PTSD Victims of 9/11

The Journal of Urban Health has published a study by New York City’s health department and the federal Centers for Disease Control’s Agency for Toxic Substances and Disease Registry. It estimated that as many as 70,000 people in New York could be suffering from PTSD because of the attacks on the World Trade Centre seven years ago today. Health officials have determined that more than 400,000 people were exposed to the tragedy on September 11, 2001. Recent data suggests that, of those who experienced the atrocity, 35,000 to 70,000 may have developed PTSD and 3,800 to 12,600 may have developed asthma. There are 71,437 people on the health registry who agreed to be monitored for up to 20 years since the disaster. "Half of those surveyed said they were in the dust cloud left by the collapsing towers, 70 per cent witnessed a traumatic sight – such as a plane hitting a tower or falling bodies – and 13 per cent were injured that day". Of the endless list of rescue and recovery workers, commuters, area workers, Lower Manhattan residents, and passersby, PTSD was highest among those who had sustained injuries (35%), followed by those with low-income (31%), and Hispanic (30%) respondents.

What is PTSD? - (The Ottawa Anxiety and Trauma Clinic)
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs as a result of exposure to an extreme traumatic stressor involving the threat of death or serious injury. The threat may be experienced directly or may involve witnessing others at risk for death or injury.

DSM-IV-TR criteria for PTSD - (National Center for PTSD)
Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning.

Criterion A: stressor - The person has been exposed to a traumatic event in which both of the following have been present:

1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

2. The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

Criterion B: intrusive recollection - The traumatic event is persistently re-experienced in at least one of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content

3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific re-enactment may occur.

4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Criterion C: avoidant/numbing - Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma

2. Efforts to avoid activities, places, or people that arouse recollections of the trauma

3. Inability to recall an important aspect of the trauma

4. Markedly diminished interest or participation in significant activities

5. Feeling of detachment or estrangement from others

6. Restricted range of affect (e.g., unable to have loving feelings)

7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Criterion D: hyper-arousal - Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:

1. Difficulty falling or staying asleep

2. Irritability or outbursts of anger

3. Difficulty concentrating

4. Hyper-vigilance

5. Exaggerated startle response

Criterion E: duration - Duration of the disturbance (symptoms in B, C, and D) is more than one month.

Criterion F: functional significance - The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

In addition, depression, alcohol/substance abuse, panic disorder, and other anxiety disorders commonly occur with PTSD.

Therapeutic Approaches Commonly Used to Treat PTSD - (Veterans Affairs Canada)

Cognitive-behavioral therapy (CBT): involves working with cognitions to change emotions, thoughts, and behaviors.

Exposure therapy: is one form of CBT that is unique to trauma treatment typically by flooding or gradually desensitizing the patient in a safe context until the trauma is no longer stressful.

Pharmacotherapy: use of medication to reduce anxiety, depression, and insomnia. It also facilitates successful participation in other forms of therapy.

Eye Movement Desensitization and Reprocessing (EMDR): involves elements of exposure therapy and cognitive-behavioral therapy combined with techniques (eye movements, hand taps, sounds) that create an alternation of attention back and forth across the person's midline.

Group treatment: trauma survivors share traumatic material within the safety, cohesion, and empathy provided by other survivors.

Brief psychodynamic psychotherapy: focuses on the emotional conflicts caused by the traumatic event, particularly as they relate to early life experiences.

Post-traumatic stress disorder may affect up to 70,000 New Yorkers: Sept. 11 study

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9/11, Anxiety, DSM, Pharmacology, PTSD, Stress, Therapy

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