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Our understanding of the psychological effects of BCN terrorism events is limited, but extrapolation from these few episodes can help us better prepare for such events in the future. What has been found from studying the effects of terrorist acts is that reactions follow those seen in other traumatic events, such as natural disasters. Recommendations and likely clinical effects are largely extrapolated from these more “usual” disaster scenarios.

Based on studies prior to September 11, primary care providers are said to manage roughly 70% of all mental health problems in the United States and that upward of 75% of all patient visits to physicians’ offices have significant or primarily psychological issues. These statistics are particularly relevant in the context of BCN terrorism. Following the September 11 terrorist attacks, a survey of primary care physicians found that nearly 80% identified terrorism-related psychosocial complaints in their patients, particularly in those areas geographically close to where the events transpired. The psychological fallout from traumatic events typically exceeds the medical consequences, in some instances by an order of magnitude. Following the 1995 Tokyo subway sarin attack, for example, 80% of those seeking medical care had no exposure to the gas. This phenomenon is seen commonly with any perceived public health or nonmedical emergency as well. During the 2003 SARS epidemic in Toronto, nearly 200 individuals sought medical evaluation for every diagnosed case of SARS. Clinicians should anticipate that anxiety and fear will result in a large number of individuals seeking care from the medical, hospital, and public health community following major disasters, public health emergencies, and of course, terrorist attacks. Although the majority of survivors experience only mild reactions, and recover fully, as many as a third may meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for anxiety, depression, or PTSD (see Table 7–3).

Increased anxiety in the context of bioterrorism may be explained by risk perception theory. Risk perception theory suggests that risks that are voluntary, controllable, distributed fairly, imposed from a known or trusted source, have the potential to benefit others, or are familiar or even natural, are handled with far greater aplomb. The willingness of American soldiers to climb the cliffs at Normandy in the face of Nazi guns, or a patient participating in a clinical trial of a new cancer drug, might be understood in light of this theory of risk perception. In contrast, BCN terrorist attacks are involuntary, imposed in the time, place, and manner chosen by an unknown, unfamiliar, or threatening source, have no goal other than harm, are not equitably distributed, and may involve the stuff of Hollywood movies such as unseen microbes, chemicals, or nuclear material. The very nature of terrorism amplifies the perception of risk and thereby influences greatly both individual or a community response to the event.

The BCN agents discussed in this book are all plausible and potentially dangerous threats. Creating a climate of ...

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