New Onset Delusions in the Aftermath of the September 11th Terrorist Attacks

The attacks on the World Trade Center on September 11, 2001 represented the most deadly act of terrorism on U.S. soil in the nation’s history. These attacks have had numerous social, political, economic, and psychological effects on individuals across the nation. Given the startling and gruesome nature of the attacks, it is not surprising that posttraumatic stress disorder (PTSD) has been one of the primary psychological sequelae of the events of September 11. Galea et al. used a random-digit dialing telephone survey to assess the prevalence of acute PTSD in adults living in Manhattan south of 110th street 5 to 8 weeks after the attacks.1 They found that 8.8% of the sampled population reported symptoms consistent with current PTSD.1 In addition, 57.8% of respondents reported experiencing at least one PTSD symptom in the past month, the most frequent being intrusive memories and insomnia. The likelihood of PTSD was found to be greatest among those who were more directly affected by the attacks—e.g., those who lost possessions, lived close to the World Trade Center, or were involved in the rescue efforts. In a separate publication, Galea et al. reported that adults living south of 110th street in Manhattan had a prevalence approximately twice that of previously reported estimates2,3 for both current PTSD (7.5%) and depression (9.7%) 5 to 8 weeks after the attacks.4 Respondents who lived south of Canal Street and were thus in closer geographical proximity to the World Trade Center showed an even higher prevalence of PTSD (20%).4 These studies suggest that the burden of PTSD is heaviest among individuals who were directly affected by the attacks. However, evidence exists that those who were less immediately affected may also have experienced PTSD symptoms. A random-digit dialing telephone survey of adults in the New York City metropolitan area conducted by Galea et al. found that only two thirds of those who met criteria for probable PTSD 6 months after the attacks on September 11 had been directly affected by the attacks, while one third had not been directly affected.5 A web-based epidemiological survey by Schlenger et al. done 1 to 2 months after September 11, 2001 found an increased prevalence of PTSD in New York City (11.2%) compared to Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%).6 The authors suggested that the lower prevalence of PTSD in Washington, DC compared to New York City may have been due to a number of different factors, including the fact that the Pentagon is more geographically distant from the city than the World Trade Center, that it is a military instead of a civilian target, and that the level of devastation at the Pentagon was much less that that at the twin towers. It has also been reported that the level of PTSD symptoms was associated both with the level of direct exposure to the attacks as well as indirect exposure via time spent viewing television coverage of the event on September 11 and several days afterwards. Thus, the incidence of PTSD symptoms in response to a large-scale frightening event may extend beyond those who were directly affected to the general population as a whole. Although PTSD is the psychiatric disorder that is classically most often associated with major traumatic events such as the attacks on September 11, other significant psychological sequelae of these attacks have also been described. For example, Vlahov et al. performed a random-digit dialing telephone survey of Manhattan residents to estimate the prevalence of increased cigarette smoking, alcohol consumption, and marijuana use after the attacks7 and found that more than one quarter of respondents (29%) reported an increase in use of at least one of these three substances. Specifically, 9.7% of all respondents had increased cigarette smoking, 24.6% had increased alcohol consumption, and 3.2% reported increased marijuana use. A higher prevalence of current PTSD and major depression was also found among those who reported