Normal distress resembles PTSD, but is not

By LaKisha Ladson / October 2011

Researchers at UT Southwestern have found that the hundreds of thousands across the country who saw and heard news coverage of the terrorist attack on New York City’s World Trade Center on Sept. 11, 2001, likely did not suffer true post-traumatic stress disorder (PTSD), unlike people in the immediate vicinity.

The research, led by internationally known disaster expert Dr. Carol North, is published in Disaster Medicine and Public Health Preparedness.

Drs. Richard King, Carol North
Drs. Richard King, Carol North

“What some people labeled PTSD may have been normal distress or some other psychological problem,” said Dr. North, professor of psychiatry, who has studied more than 3,000 survivors of major disasters. “It’s important that we correctly identify psychiatric disorders so we can truly meet the needs of people suffering any type of mental illness or condition, and appropriately address psychological suffering that is very prevalent but does not constitute psychiatric illness.”

Her team interviewed nearly 380 survivors of the 9/11 attacks assessed at both three and six years after the event through careful assessment of PTSD according to the most current diagnostic standard for evaluating psychiatric disorders. The UT Southwestern scientists and colleagues found about one-third of survivors directly exposed to danger in the attacks event developed PTSD, consistent with Dr. North’s findings from her study of directly exposed survivors of 1995’s Oklahoma City bombing. They also found that most PTSD sufferers after the 9/11 attacks in New York City were within a block of the attack.

“Although the 9/11 terrorist attacks constituted an undeniable trauma, very few people without exposures as defined by the criteria for PTSD developed the symptoms of PTSD,” said Dr. North, also director of the program in Trauma and Disaster at the Veterans Affairs North Texas Health Care System.

PTSD is an anxiety disorder with demonstrated effective treatments, but it is also a complicated disorder to assess. By definition PTSD requires exposure to the trauma, and in the case of the Sept. 11 attacks in New York, that would include being in the towers, witnessing people being injured or killed in person, or having a close family member or friend directly exposed to the attacks.

Other UT Southwestern researchers involved in the study were Dr. Richard King, associate professor of health care sciences and emergency medicine, and Dr. Alina Suris, associate professor of psychiatry. Researchers from the University of Alabama, Mount Sinai School of Medicine in New  York, Cedar-Sinai Medical Center in Los Angeles, Washington University School of Medicine in St. Louis, UT Dallas, New York University Silver School of Social Work, Columbia University and the University of Oklahoma Health Sciences Center.


Dr. North holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry.

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