Post 9/11 Trauma: Speech to Rotary Club 11/01

Dr. Karen’s Speech To Rotary Club 11/01

Hi. Thanks for inviting me. I know that we’re all anxious about what happened on 9/11 and I am hoping today’s discussion will allay some of the fears by talking about the Psychological Reactions to Trauma, known as PTSD, or Post-traumatic Stress Disorder, that so many of us are experiencing in the wake of the disaster.

First, let me briefly explain what Post-Traumatic Stress disorder is, and why, even those of us who witnessed it on television and were not physically present at the sites, are still experiencing symptoms. PTSD is an anxiety disorder. It occurs when an overwhelming, unexpected trauma causes feelings of shock, emotional turmoil, and helplessness. Whether watching it on T.V. or experiencing it first-hand, your brain releases adrenaline, the chemical that causes the fight or flight reaction. You switch from normalcy into a heightened reactive state, of PANIC. Of fundamental importance is that most humans need to believe that life is predictable, that we are in control, and after teh horror of what we saw on 9/11, We have Lost our sense of security. We feel powerless. Our core belief that we have control over our world is shaken.

Something unexpected, and unthinkable happened and we are totally helpless to stop it. Our brains go into emotional overload: We react or obsess. We desperately want to do something. But what?

Should we give blood? Volunteer? Run out and buy Zipro packs? We worry, Where will the next attack occur, Are we safe? And many of us baby boomers are experiencing the terrifying reality that our next egg has eroded, our stock portfolio’s have plummeted, and we are frightened by the uncertainty about our financial futures.

I’m handing out the Diagnostic Criteria for PTSD for anyone who’s interested to review at home, but for now, I’d like to talk about LEARNING TO LIVE PAST 8:45 AM ON SEPT. 11. So I’d going to open this to a group discussion. A great way to get over the anxiety and sadness is by talking.

DSM-IV-TR criteria for PTSD
In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The diagnostic criteria (Criterion A-F) are specified below.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 reenactment 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.

Specify if:
Acute: if duration of symptoms is less than three months

Chronic: if duration of symptoms is three months or more

Specify if:
With or Without delay onset: Onset of symptoms at least six months after the stressor

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR ( Fourth ed.). Washington D.C.: American Psychiatric Association.