Ethically Treating PTSD Resulting from Terrorism and other Traumas

Prior Experience and Training
To further explain PTSD resulting from terrorism and other traumas, we have just discussed four losses trauma survivors may face.

4 Losses Trauma Survivors May Face
1. Loss of their feeling of invulnerability.
2. Loss of an orderly world.
3. Loss of a positive self-image.
4. Loss of trust.

Now, let's look at the role that prior experience and training make in a predisposition to PTSD resulting from terrorist attacks. Two factors that affect the individualized response to the stressor of terrorism: first, life experiences before the incident, and second, the behavioral response repertoire that the victim brings to it. As I am outlining these, think about clients you are treating or have treated and ask yourself if any fit into these categories.

2 Factors that Affect the Individualized Response to the Stressor of Terrorism

#1 - Life Experiences Before the Incident
The first factor is the role that prior training plays. Some individuals, such as military or diplomatic personnel, may have had prior training that enables them to mobilize a wide range of conscious adaptive behaviors in addition to unconscious defense mechanisms that affect their response to the stressor of terrorism. Presumably, they might have better adaptive advantages in a terrorist situation compared with individuals who have had little or no prior experience.

For example, one contributor to the relatively low level of psychopathology manifested by the American hostages in Iran was their prior experiences and training in the foreign service and military fields. Ask yourself, are any of your current clients military or diplomatic personnel with training regarding terrorism?

#2 - Personality Type
Secondly, personality type is another important factor which determines coping behaviors. Studies of prisoners of war and concentration camp survivors have shown that certain personality types adapt more successfully than others under identical circumstances. As an example, Ford and Spaulding psychiatrically evaluated the 82 surviving USS Pueblo crew members who were captured and imprisoned in North Korea for 11 months in 1968. Those men who adapted poorly to the prolonged stress were frequently evaluated as being passive-dependent, whereas those who coped well with the stress most often had personality diagnoses of healthy or schizoid.

As you know, the DSM defines the Schizoid Personality Disordered patient as being indifferent to the society of other people, sometimes profoundly so. Typically, the Schizoid Personality Disordered patient is a lifelong loner who shows a restricted emotional range; he or she appears unsociable, cold and seclusive. Thus, your clients' prior training and personality type may determine greatly the meaning of the stress of the experience for them. Ask yourself, “which one of my current or past clients would fare best in a hostile or hijack situation?”

3 Self-Assumptions
After the terrorists attack, we all had to reconsider at least three assumptions about ourselves:
1. I am personally invulnerable; we as a nation in the United States are invulnerable to terrorist attacks;
2. The world is orderly and meaningful, and in an orderly world there are no attacks on U.S. soil; and
3. We are a good and strong people. Thus, others will not attack us.

As a nation we all had these basic assumptions shattered at a certain level in the same way that direct victims of the attacks questioned these assumptions. The professional code of ethics emphasizes self awareness...ask yourself where are you personally regarding personal invulnerability, feeling the world is orderly, and that we are a good and strong people not a target for an attack. To what extent has your shattered assumptions affected your treatment of clients? Or has it affected your treatment of clients?

Online Continuing Education QUESTION 3: What are three assumptions about ourselves that we as a nation have been forced to reconsider? To select and enter your answer go to CEU Answer Booklet.