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Researchers addressed the long-term effects of trauma in direct survivors of the bombing and their children in the fourth study. Ironically, this study was scheduled to begin in September 2001. The terrorist attacks in New York, Washington, D.C., and the plane that crashed in rural Pennsylvania, as well as the anthrax-based bioterrorism scares that followed, raised concern that acts of terror would continue to escalate.

Consequently, researchers resumed their work, using a noninvasive, low-stress interview process that involved recall and verbalization of bombing memories. Age- and gender-matched community-control groups were also included. The research team conducted physiologic assessments and looked at cortisol levels and symptoms of PTSD and depression. When they crunched the data, researchers were surprised.

“We found that adult survivors who were directly impacted had an increase in their heart rate and blood pressure during the interview,” Tucker says. “What we didn’t expect to find was that their children also had an increase in heart rate and blood pressure.”

Tucker says the findings support “an intergenerational transmission of the trauma experience from the empathic parent to the child.”

This phenomenon has also been seen in survivors of the Holocaust and their children. The “inheritance” of trauma is associated with the parents’ high levels of anxiety and subsequent inability to maintain a balanced perspective in the face of difficult circumstances. These negative coping mechanisms can significantly interfere with children’s developmental progress.

Another interesting outcome of the fourth study was that the adult community age -and gender-matched control group also expressed increased physiological responses — increased heart rate and blood pressures — during the interviews, although not to the extent of the direct victims.

“In a disaster community, everyone is exposed to some degree,” Tucker says.

The body remembers

Although cortisol levels in the direct survivors as a whole were the same as the comparison subjects, Tucker says in 10 survivors with documented cases of PTSD, cortisol levels tested high.

“Cortisol is a stress hormone,” she explains. “If you’re in a motor vehicle accident, you have high cortisol levels. In PTSD, you see low cortisol levels.”

Initially puzzled, researchers attribute this increase to the anxiety of study participation and retrospective reporting. “Even after six or seven years, direct survivors of terrorism carry bodily memories of the trauma, even if they report they are doing well overall,” Tucker says. “There is still something that increases their heart rate and blood pressure when they remember events.”

Although researchers don’t know if their findings will correspond with a risk for developing cardiovascular disease down the road, they do indicate a readiness for the fight or flight response.

“Something that’s learned at the point of trauma is kicked in that prepares people for action in case there’s another attack,” she says. “It shows that something lingers on.” According to Tucker, research is ongoing in an effort to understand resilience, including not getting ill, recovery, getting over illness, and post-traumatic growth.

Although the research continues, Tucker says insight has definitely been gleaned from the studies. In addition to identifying a novel predictor of PTSD, paranoid tendencies at the time of a terrorist act, researchers also documented the effective coping mechanisms of altruism, group support, and having a positive outlook. They also recognized that those with a history of going through terror or violence are more vulnerable, that trauma can be transmitted environmentally, and that somatic memories of trauma are real.

“Health care policy-makers can use this information to provide effective treatments immediately after a disaster and over the long haul,” Tucker says. “Our colleagues in New York City and other places have been very interested in what we’ve found.”

Elissa Crocker, RN, BSN, is a freelance writer.