Page 228 - Creating Spiritual and Psychological Resilience

Fundamentals of Working With (Re)traumatized Populations 197

3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have loving feelings)
7. Sense of foreshortened future (e.g., does not expect to have a career,
marriage, children, or a normal life span)

Criterion D: Persistent symptoms of increased arousal (not present
before the trauma), as indicated by two (or more) of the following:

1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hypervigilance
5. Exaggerated startle response

A particularly salient example is of the many survivors of previous
trauma living in the United States who were particularly shaken by the ter-
rorist attacks on September 11, 2001,because, until then, they had viewed

America as their “last place of safety.” As part of their adaptation to prior
massive trauma, it was inconceivable to them that the United States, in
general, and New York, in particular, could be a place of vulnerability or
that they would be unsafe again, here. For some, specific features of the
terrorist attacks served as triggers, as well as aspects that were symbolic
of past trauma, and then reactivated past symptoms (e.g., incineration for
Holocaust survivors and their offspring, or absence of remains for rela-
tives of the “disappeared” from some Latin American countries and from
Bosnia and Herzegovina; see also, e.g., Kinzie, Boehnlein, Riley, & Sparr,
2002). American former prisoners of war (POWs), having lived through
the attack on Pearl Harbor, combat, and imprisonment, and who were
already well aware of life’s unpredictability and fragility, were also affected
by 9/11. Rodman and Engdahl (2002) found a small but significant increase
in PTSD-related distress among 117 WWII and Korean War POWs sur-
veyed in July 2002, indicating that the past can symbolically come alive in
the face of present distress, despite the passage of time.
Trautman and colleagues (2002) similarly report that PTSD symp-
tomatology from prior trauma in Asian and Middle Eastern immigrants
was most predictive of initial physiologic and emotional response to the
Oklahoma City 1995 bombing and of later bomb-related PTSD symptoms.
They also found that bomb-related PTSD symptoms increased with age