The Trauma of 9/11 Still Grips Many

Healing process slow for those with post traumatic stress

WEDNESDAY, Sept. 11, 2002 (HealthDayNews) -- The terrorist attacks of September 11 left everyone struggling with a storm of emotions, ranging from disbelief and anger to depression and anxiety.

For some, the storm has yet to subside.

Those hurting the worst may have post traumatic stress disorder, or PTSD, a psychiatric condition most commonly associated with combat soldiers but one that can also affect anyone who has been severely traumatized.

Exactly how many have PTSD as a result of the 9/11 attacks is still being studied. Earlier this year, New York researchers estimated that about 20 percent of New York City residents living south of Canal Street, nearest the World Trade Center, showed symptoms of PTSD.

Last week, the Centers for Disease Control and Prevention reported that 75 percent of more than 3,500 residents of New York, New Jersey and Connecticut who were polled from last October to the end of 2001 said they had psychological problems after the attack, although it's not known exactly how many developed PTSD.

This week, the New York Academy of Medicine's Center for Urban Epidemiological Studies estimated that 585,000 New Yorkers had PTSD symptoms last September and 91,000 are believed to have the disorder still.

For those who have it, there's hope and help. From years of working with combat veterans and others, experts know how to treat the condition effectively.

Those who suffer it can have flashbacks and nightmares, difficulty sleeping, feelings of detachment and trouble just getting through the day. PTSD can be acute, occurring in the days or weeks after the crisis, and it can also become chronic.

Although some contend that one never "gets over" PTSD, others take a brighter outlook.

"Yes, it alters your life, but it doesn't mean you can't recover," says Charles Flora, a U.S. Department of Veterans Affairs social worker who has counseled many PTSD clients.

"You process through, you give it a new sense of meaning, you understand it," says Flora, who is the associate director of the readjustment counseling service of the Vet Center Program. Hopefully, he adds, you get back into the mainstream of life, with job and relationships intact.

What Flora can't predict is how soon anyone might do that. It depends on the scope of the trauma and the effect on the person, as well as factors such as personality and coping styles. "It's different in different people," he says.

"Everyone's PTSD is different," agrees Dr. Eric Braverman, a New York physician who estimates he has counseled up to 100 persons exhibiting PTSD symptoms in the aftermath of the terrorist attacks, including one patient who lost 70 friends in the attack.

Besides confirming that the problem is PTSD, Braverman looks at physical factors that might be worsening the problem, such as depression or undiagnosed medical problems.

"Trauma acts like a lever, prying loose ailments that lie below the surface," he says. "Once we decide how much is psychological and how much is medical, we proceed."

Treatment should include not only the person with PTSD but loved ones, Flora says, because educating the family about the condition is crucial.

When those with PTSD ready, they are encouraged to expose themselves to the trauma again via imagery and also examine their reactions and beliefs with a goal of feeling more in control.

Trauma memories must be processed, too, Flora says. "You teach them to reprocess the troubling experience but in a way that helps them recover."

Medication may be prescribed to help cope with sleep problems, depression and anxiety.

Group therapy is often recommended, Flora says, because people can help each other and not feel like they're going through the trauma alone. It's a good place, he says, to examine strong feelings such as anger, shame or guilt, and come to terms with them.

Survivors' guilt is common among those who survived war or the World Trade Center and Pentagon attacks.

Those who have symptoms of PTSD might make it a point, Flora says, to participate in this week's memorial services. He compares it to war veterans who organize trips to war memorials: "These [trips] provide mechanisms for vets to heal."

To overcome PTSD, Flora says, it's crucial to create a safe environment in which the traumatic stories can be told. It's also vital to help those who suffer to reconnect with society. Avoidance of social situations is a common pattern of vets with PTSD, he says, and it makes them feel isolated and alone.

Those who have PTSD symptoms should expect a rough week, Flora says. "It may feel like the whole thing is coming back. Some may feel afraid of being overwhelmed." Being prepared for a rough time is half the battle, he says.

"Don't be surprised," he tells those with PTSD, "if you have a few emotional responses this week."

What To Do

For more on PTSD, see the National Center for PTSD or the National Institute of Mental Health.

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