World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders

Abstract

The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on “Trauma and Stressor Related Disorders,” a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.

Keywords:

• WTC Health Program
• 9/11 psychological trauma
• PTSD
• trauma related disorders
• adjustment disorders

Acknowledgments

The authors would like to thank all the World Trade Center rescue, recovery, and cleanup workers and 9/11 survivors who participate in the World Trade Center Health Program, and the healthcare providers committed to caring for them.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Disclosure statement

No potential conflict of interest was reported by the authors.

Institutional review board (IRB) review

This activity did not involve human subjects and therefore did not require IRB review.

Notes

1 Probable WTC-related PTSD level (none, subthreshold, or full PTSD) was assessed based on DSM-IV criteria using the PTSD Checklist-Specific Stressor version.

2 For a scoping review of research on WTC related conditions including risk and protective factors, please see: Translational Impacts of World Trade Center Health Program Research: A Mixed Methods Study | RAND

3 Practice guidelines suggested in this paper were identified from the ECRI (Emergency Care Research Institute) Guidelines Trust (https://guidelines.ecri.org/), a compendium of CPGs that meet prespecified inclusion criteria (see Calvert et al., 2023).

Additional information

Funding

Dr. Lowe is supported by CDC/NIOSH Contract 200-2017-93428. Drs. Haugen and Werth are supported by CDC/NIOSH Contract 200-2017-93430. Dr. Rosen is supported CDC/NIOSH Contract 200-2017-93427 and CDC/NIOSH Data Center​​ Contract 200-2017-93327.