Center for the Study of Traumatic Stress Understanding the Effects of Trauma and Traumatic Events to Help Prevent, Mitigate and Foster Recovery for Individuals, Organizations and Communities

Introduction An attack using radiation will create uncertainty, fear, and terror. Following the detonation of a Radiation Dispersal Device (RDD) the management of acute psychological and behavioral responses will be as important as the treatment of RDD-related injuries and illnesses. Radiation is a dreaded threat, usually seen as catastrophic and fatal. Radiation is invisible, odorless and unknown. These ingredients stimulate worst-case fantasies. People must rely on health care providers and scientists to determine whether or not a person has been contaminated. Radiation exposure may not be manifest immediately. The health effects of radiation can be delayed in time, not only affecting those exposed but also future generations. Those who have been exposed or anticipate possible exposure feel a sense of vulnerability, anxiety, and a lack of control. The common lack of consensus among experts can increase public fear and anger. After a terrorist event there are three groups of psychological responses: those who are distressed; those who manifest behavioral changes; and those who may develop psychiatric illness. Distress following a radiation release will be common and manifest as sadness, anger, fear, difficulty sleeping, impaired concentration, and disbelief. Psychological distress after a radiologic icident may also manifest as somatic complaints for which no diagnosis can be found (often referred to as “MIPS” — Multiple Idiopathic Physical Symptoms. These patients should be managed by general health care providers. Some individuals will manifest changes in their behavior such as decreasing travel, staying at home, refusal to send children to school as well as increased smoking and alcohol use. For the vast majority of people, distress and psychological and behavioral symptoms related to the traumatic event exposure will diminish over time. For others, however, symptoms will persist and affect function at home and work, and may result in psychiatric illness. While Acute Stress Disorder (ASD) and PostTraumatic Stress Disorder (PTSD) are the disorders most people think of in connection with trauma, major depression, increased substance use, family conflict, and generalized anxiety disorder are also encountered. It is important to remember that people with no prior history of psychiatric illness are vulnerable to psychiatric illness after a terrorist exposure. In the aftermath of the Oklahoma City bombing, nearly 40% of those who developed PTSD and depression had no previous psychiatric disorder. Those at high risk of developing psychiatric disorders include: