Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism

Objective: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast. Method: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments. Results: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects. Conclusions: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems.