News coverage on Sept. 11 spread the day's violent images — and at least some of their psychological effect — well beyond the site of the former World Trade Center. A Web-based study that queried a national sample of adults one to two months after the attack found that 4.3% had stress reactions that qualified as PTSD — and rates were highest among those who had watched more than 12 hours of television coverage of the event per day or reported having seen a high number of Sept. 11-related graphic images on TV. Those who had seen very little coverage were least likely to report symptoms, according to the study, which was published in the Journal of the American Medical Assn.
Other national surveys that gauged the nation's distress after Sept. 11 found that debilitating symptoms of stress dissipated quickly in people who weren't directly affected by the events. That suggests that images alone are not enough to cause the condition, at least in most cases, the drafters of the psychiatric manual concluded.
Is PTSD real if it develops years after a traumatic event?
It certainly can be, as Esperanza Muñoz's case demonstrates. After Sept. 11, studies found that the onset of the disorder was very often delayed among firefighters and emergency responders — workers whose training allows them to suppress their initial reactions to trauma and gore. That cast new light on the cases of many veterans — including those who fought in Vietnam — who developed PTSD symptoms years after their return home.
The fact that post-Sept. 11 PTSD was more common in people who had experienced previous traumas — such as physical or sexual abuse as a child — also suggests that symptoms may not always develop immediately, experts say. The survivor of one trauma may be scarred but not broken by her first experience, but that wound may reopen in response to a fresh trauma.
Figley says that's a key lesson learned in the decade since Sept. 11: that a person's response to trauma is defined by the lifetime of experience she brought to the event.