Psychiatric trauma in the age of terrorism: A commentary on "psychiatric disorders among victims of a courthouse shooting spree"

Abstract

The preceding article by Johnson, North, and Smith does a marvelous job of describing how to research the psychiatric impact on victims of traumatic events. In the wake of the 9-11 attacks on New York and the Pentagon, such findings can be most useful. There is clearly a need to quickly understand what we might expect the psychiatric consequences of the recent and future terrorist events to be, so that planning for effective prevention and individual and population based interventions can be developed. The authors establish credibility for their conclusions by the rigor of their research design and the reliability of their interview instruments. They perceptively and wisely point out that persons who experience such traumatic events have a wide range of psychiatric symptoms. These symptoms are sufficient in some cases to meet DSM criteria for mood, anxiety, and substance use disorders, but many victims have significant subsyndromal consequences, which may cause interpersonal or other functional difficulties, whether or not they meet criteria for active treatment intervention. They also confirm the observation of others that those persons with pre-existing psychiatric disorders are at the greatest risk of developing trauma related conditions following such an event. We may be able to develop prevention strategies for case finding after traumatic events that include soliciting prior psychiatric history from apparent victims.