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Background: The course of posttraumatic stress disorder (PTSD) in populations directly exposed to terrorist attacks is of major importance in the post-9/11 era. Because no systematic diagnostic studies of the most highly exposed individuals of the 9/11 terrorist attacks have yet been done, the Oklahoma City bombing remains a unique opportunity to examine PTSD over time in high-exposure terrorist victims., Methods: This study assessed 137 survivors in the direct path of the explosion at approximately 6 and 17 months postdisaster, using the Diagnostic Interview Schedule., Results: Combined index and follow-up data yielded a higher (41%) incidence of PTSD than detected at index (32%) or follow-up (31%). All PTSD was chronic (89% unremitted at 17 months) with no delayed-onset cases. The avoidance and numbing symptom group C, unlike groups B and D alone, was pivotal to current PTSD status and was associated with indicators of functioning at index and follow-up. The findings at index were sustainable., Conclusions: This follow-up study confirmed the immediacy of onset of PTSD and its persistence over time, pointing to the need for early interventions that continue over the long term. Group C avoidance and numbing symptoms may aid in early recognition of PTSD and in predicting long-term functioning.

This study assessed teachers' reactions to the Oklahoma City bombing. Peritraumatic reactions, the interaction of media exposure with stress from media coverage, feelings toward the perpetrators, and worry about safety predicted posttraumatic stress. Twenty percent reported difficulty handling demands; 5% sought counseling. Outreach efforts should assess and assist teachers.

Studies have demonstrated a positive relationship between exposure and posttraumatic stress, but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of posttraumatic stress than more objective measures of exposure. We examined the role of peritraumatic response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Oklahoma City, Oklahoma, bombing. While many children reported hearing and feeling the blast and knowing direct victims, most were in school at the time of the explosion and therefore were not in direct physical proximity to the incident. Physical, interpersonal, and television exposure accounted for 12% of the total variance in our measure of posttraumatic stress when peritraumatic response was ignored. Peritraumatic response and television exposure accounted for 25% of the total variance, and physical and interpersonal exposure were not significant in this context. These findings suggest the importance of peritraumatic response in children's reactions to terrorism. These early responses can be used to help determine which children may experience difficulty over time.

In this study, we examined the effect of trauma exposure on substance use behaviors, specifically tobacco and alcohol use, in a group of 84 individuals who sought supportive services after the 1995 Oklahoma City bombing. A self-report instrument was used to assess demographics, sensory exposure, injury, interpersonal exposure through relationship with victims, peritraumatic reaction, grief, posttraumatic stress, worry about safety, functional impairment, and changes in smoking and drinking. Those who reported increased smoking had higher scores on peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning. Those who reported increased alcohol intake had higher scores on injury, peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning. Sensory exposure and interpersonal exposure were not significantly different between those with and without increased smoking or drinking. Although no causal relationship can be assumed, our findings indicate an association of grief and posttraumatic stress with increased substance use behaviors in disaster victims.