Panic Reactions to Terrorist Attacks and Probable Posttraumatic Stress Disorder in Adolescents

University of Oklahoma Health Sciences Center, Oklahoma City, 73104, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 04/2006; 19(2):217-28. DOI: 10.1002/jts.20118
Source: PubMed


A number of factors, including subjective reactions and appraisal of danger, influence one’s reaction
to a traumatic event. This study used telephone survey methodology to examine adolescent and parent
reactions to the 2001 World Trade Center attacks 6 to 9 months after they occurred. The prevalence of
probable posttraumatic stress disorder (PTSD) in adolescents was 12.6%; 26.2% met study criteria for
probable subthreshold PTSD. A probable peri-event panic attack in adolescents was strongly associated
with subsequent probable PTSD and probable subthreshold PTSD. This study suggests that the early
identification of peri-event panic attacks following mass traumatic events may provide an important
gateway to intervention in the subsequent development of PTSD. Future studies should use longitudinal
designs to examine the course and pathogenic pathways for the development of panic, PTSD, and other
anxiety disorders after exposure to disasters.

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    • "The detrimental consequences of political violence for children's and adolescents' psychological distress have been documented in the United States (DeVoe, Klein, Bannon, & Miranda-Julian, 2011; Hoven, Duarte, & Mandell, 2003; Hoven et al., 2005; Pfefferbaum, Stuber, Galea, & Fairbrother, 2006) and worldwide (Moscardino, Scrimin, Capello, & Altoe, 2010; Pat-Horenczyk et al., 2009; Peltonen , Qouta, El Sarraj, & Punamaki, 2010; Punamaki, 2008). The most prominent and well-documented effects of exposure to war are Posttraumatic Stress Syndrome (PTS) and Posttraumatic Stress Disorder (PTSD) (Garbarino & Kostelny, 1996; Gurwitch, Pfefferbaum, & Leftwich, 2002; North & Pfefferbaum, 2002; Pat- Horenczyk, 2005). "
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    ABSTRACT: This study examined one-year after effects of exposure to war events on adolescents' Posttraumatic Stress Symptoms (PTS) and risk behaviors (substance use and involvement in school violence). In addition, it addressed two potential vulnerability factors: at the micro level, it examined whether childhood trauma raised the vulnerability of Israeli adolescents to PTS and risk behaviors when exposed to war events. At the macro level, we explored whether ethnicity, i.e., being an Israeli Arab, is a vulnerability factor to PTS and risk behaviors. We used a representative sample of 7th to 11th grade students from the north of Israel that included 4151 students: 1800 Jewish (54.4% boys) and 2351 Arab (41.5% boys). We assessed exposure to war events and childhood traumatic events, PTS and PTSD, substance use (alcohol, cannabis, Ecstasy) and involvement in school violence. The findings revealed extensive exposure to war events among both Jewish and Arab students. A year after the war, its effects on adolescents were still manifested in PTS, and involvement in school violence and substance use. Exposure to child physical abuse was associated with higher levels of PTS symptoms, substance use and involvement in violence. Exposure to other traumatic events was also associated with greater PTS symptoms and involvement in violence but not with greater substance use. Arab students were a more vulnerable population. They reported higher PTS symptoms, more cannabis use and greater involvement in school violence than Jewish students. However, exposure to war events had similar effects on both Arab and Jewish students. We conclude that war effects include a broad range of psychological distress and risk behaviors that last long after the war ends, especially among youth who have experienced childhood trauma and high exposure to war-related stressors.
    Social Science [?] Medicine 06/2012; 75(7):1321-8. DOI:10.1016/j.socscimed.2012.05.010 · 2.89 Impact Factor
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    • "A substantial proportion of persons with PD/A report a history of trauma (e.g., David, Giron, & Mellman, 1995; Falsetti, Resnick, Dansky, Lydiard, & Kilpatrick, 1995; Leskin & Sheikh, 2002). Moreover, research has shown that the majority of trauma survivors experience panic attacks during their trauma (e.g., Bryant & Panasetis, 2001; Nixon & Bryant, 2003; Pfefferbaum, Stuber, Galea, & Fairbrother, 2006), and that the presence of peritraumatic panic attacks is predictive of the development of acute stress disorder (ASD) and PTSD (Bryant & Panasetis, 2001; Nixon & Bryant, 2003; Pfefferbaum et al., 2006). Ongoing panic attacks appear to be common in persons with ASD or PTSD. "
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    ABSTRACT: Although research on the hierarchical model of anxiety and depression has confirmed that autonomic arousability (AA) is more germane to panic disorder with or without agoraphobia (PD/A) than other DSM-IV anxiety and mood disorders, studies have not evaluated the differential relevance of AA to posttraumatic stress disorder (PTSD). This issue was addressed in multivariate analytic models using 295 outpatients with anxiety and mood disorders. Consistent with prediction, the presence of current DSM-IV PTSD and PD/A was significantly predictive of AA, even when other forms of anxiety disorder comorbidity were held constant. Moreover, latent structural analyses indicated that PTSD and PD/A were the only DSM-IV anxiety disorder constructs to have significant direct effects on AA (in accord with previous findings, the DSM-IV constructs of generalized anxiety disorder, social phobia, and obsessive-compulsive disorder did not have significant structural relationships with AA). The current findings, which attest to the specificity of AA to PTSD and PD/A, are discussed in context of other clinically salient shared features of these disorders and their relevance to treatment and diagnostic classification.
    Behaviour Research and Therapy 04/2009; 47(6):487-93. DOI:10.1016/j.brat.2009.02.016 · 3.85 Impact Factor
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    • "Peritraumatic panic was not predictive of PTSD, binge drinking, physical health status, or postdisaster mental health service use 2 years post-trauma, once these risk/protective factors were controlled. Given previous research (Bryant and Panasetis, 2001; Nixon and Bryant, 2003; Lawyer et al., 2006; Person et al., 2006; Pfefferbaum et al., 2006), this seems to suggest that focusing on PPAs post-trauma might be somewhat misguided, especially in terms of clinical interventions related to experiencing of fear and panic symptoms and modification of cognitive arousal processes related to these symptoms (Nixon et al., 2004). As we noted above, and contrary to PPA conceptualizations, experiencing negative life events and lower self-esteem in the follow-up year are better in predicting longer-term health outcomes than PPA, per se, suggesting that a clinical focus on resiliency and coping skills might potentially be more beneficial (Boscarino et al., 2006b; Bonanno et al., 2006). "
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    ABSTRACT: Several studies have suggested that experiencing a peritraumatic panic attack (PPA) during a traumatic event predicts future mental health status. Some investigators have suggested that this finding has psychotherapeutic significance. We assessed the hypothesis that PPA was not related to longer-term health status after event exposure, once background confounders were controlled. In our study we assessed exposure to the World Trade Center disaster (WTCD) and other negative life events, demographic factors, social support, self-esteem, and panic attack onset in predicting health outcome among 1681 New York City residents 2 years after the attack. Initial bivariate results indicated that a PPA was related to a number of adverse outcomes 2 years after the WTCD, including posttraumatic stress disorder, depression, poor physical health, anxiety, binge drinking, and mental health treatment seeking. However, when multivariate (MV) models were estimated adjusting for potential confounders, most of these associations were either non-significant or substantially reduced. Contrary to previous predictions, these MV models revealed that recent negative life events and current self-esteem at follow-up were the best predictors of health outcomes, not PPA. Although post-trauma interventions may target individuals who experienced PPA after traumatic exposures, reducing the long-term health consequences following such exposures based on PPA alone may be problematic. Modifications of psychopathology constructs based on the reported correlation between PPA and post-trauma outcomes may be premature.
    Psychiatry Research 04/2009; 167(1-2):139-50. DOI:10.1016/j.psychres.2008.03.019 · 2.47 Impact Factor
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