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Ann Clin Psychiatry. 2004 Oct-Dec;16(4):209-15.

The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing.

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  • 1Washington University School of Medicine, Department of Psychiatry, St. Louis, MO 63110, USA.



The course of posttraumatic stress disorder (PTSD) in populations directly exposed to terrorist attacks is of major importance in the post-9/11 era. Because no systematic diagnostic studies of the most highly exposed individuals of the 9/11 terrorist attacks have yet been done, the Oklahoma City bombing remains a unique opportunity to examine PTSD over time in high-exposure terrorist victims.


This study assessed 137 survivors in the direct path of the explosion at approximately 6 and 17 months postdisaster, using the Diagnostic Interview Schedule.


Combined index and follow-up data yielded a higher (41%) incidence of PTSD than detected at index (32%) or follow-up (31%). All PTSD was chronic (89% unremitted at 17 months) with no delayed-onset cases. The avoidance and numbing symptom group C, unlike groups B and D alone, was pivotal to current PTSD status and was associated with indicators of functioning at index and follow-up. The findings at index were sustainable.


This follow-up study confirmed the immediacy of onset of PTSD and its persistence over time, pointing to the need for early interventions that continue over the long term. Group C avoidance and numbing symptoms may aid in early recognition of PTSD and in predicting long-term functioning.

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