Resilience and vulnerability in coping with stress and terrorism.

Abstract

The immediate response to the traumatic event in individuals who may develop ASD2 or PTSD involves intense fear, helplessness or horror. ASD is experienced during or immediately after the trauma, lasts for at least 2 days, and either resolves within 4 weeks or the diagnosis has to be adjusted. A diagnosis of PTSD may be appropriate provided the full criteria for PTSD are met [2]. Of individuals who respond to the trauma with intense fear or horror 15–35% will eventually develop a significant degree of dysfunction and distress [3], namely PTSD, for a considerable length of time. The PTSD symptoms can be grouped into three main clusters. The first is persistent re-experience of the traumatic event, such as recurrent dreams and flashbacks. The second is persistent avoidance of internal or external cues associated with the trauma, such as avoiding thoughts, avoiding activities, diminished interest, detachment, restricted affect, and sense of foreshortened future. The third is increased arousal, which is manifested as difficulty in concentrating, hypervigilance, and exaggerated startle response [2]. The marked discrepancy between the proportion of the general population exposed to traumatic events and the proportion that ultimately fulfills the criteria for PTSD is a challenging aspect of the study of stress-related disorders. Identification of factors that increase vulnerability of individuals and factors that increase resilience may have important implications in public health. In this issue of IMAJ, Amital and colleagues [4] report on the short-term