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 ...