PTSD Nation: 9/11’s Health Consequences For Us All

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One of the things most troubling about 9/11 is that many people in Maine continue to live their lives in direct response.  We have a number of former New Yorkers who sold everything and moved to Maine with the idea that they would escape the next attack.  Even though it hasn’t happened, that same anxiety is now refocused on every new or perceived threat.  Instead of the nightly news acting as information, it becomes a rallying cry for action or at least continued terror.

In the days following 9/11, I remember feeling dazed.  As a nation, we were in shock.  As a homeopath, the treatment for that shock is aconite (30c or above).  When we look at the ongoing effects of working in the dust of 9/11, obstructive sleep apnea continues to be a concern.  These brave men and women are experiencing both the continued physical effects and the continued emotional effects of that series of events.  Looking at the description for aconite gives a sense of what they continue to go through.

But the entire nation witnessed and rewitnessed the events of 9/11.  Our entire psyche changed and we went into a PTSD mode.  Our ongoing legacy of that may well be an aspect of the polarization of the nation and our increasing obesity epidemic.  The literature on this is interesting.  People with PTSD have more difficulty listening well.  And chronic stress shifts gradually to chronic weight gain as the abdominal fat responds to the increased need for those hormones by expanding.

Sleep Breath. 2010 Jul 1. [Epub ahead of print]

Prevalence and incidence of high risk for obstructive sleep
apnea in World Trade Center-exposed rescue/recovery workers.

Webber MP, Lee R, Soo J, Gustave J, Hall CB, Kelly K,
Prezant D.


Department of Epidemiology and Population Health, Montefiore
Medical Center and Albert Einstein College of Medicine, 111 East 210th Street,
Bronx, NY, 10467, USA,



World Trade Center (WTC)-exposed rescue/recovery workers
continue to have high rates of gastroesophageal reflux disease (GERD), chronic
rhinosinusitis, and posttraumatic stress disorder (PTSD) symptoms. This study
examines the relationship between these WTC-related conditions and being at
high risk for obstructive sleep apnea (OSA).


The Fire Department of the City of New York (FDNY) performs
periodic health evaluations on FDNY members every 12 to 18 months. Evaluations
consist of physician examinations and self-administered health questionnaires,
which, since 2005, have incorporated questions about sleep problems that were
adapted from the Berlin Questionnaire. The study population consisted of 11,701
male firefighters and emergency medical service personnel. Incidence analyses
were limited to a cohort (n = 4,576) who did not meet the criterion for being
at high risk for OSA at baseline (between September 12, 2005 and September 8,
2006) and had at least one follow-up assessment, on average, 1.4 (+/-0.5) years


The baseline prevalence of high risk for OSA was 36.5%. By
follow-up, 16.9% of those not at high risk initially became at high risk for
OSA. In multivariable logistic regression models predicting incident high risk
for OSA, independent predictors included: earlier time of arrival at the WTC
site, GERD, chronic rhinosinusitis, PTSD symptoms, self-assessed fair/poor
health, low body mass index (BMI < 18.5 kg/m(2)), and, as expected, BMI >
30 kg/m(2) and weight gain of >/=10 lb (4.5 kg).


We found significant associations between being at high risk
for OSA and common WTC-related conditions, although the responsible causative
mechanisms remain unknown. Since the etiology of OSA is likely multifactorial,
improvement may require successful treatment of both OSA and its comorbid

PMID: 20593281

Int J Psychophysiol. 2008 Apr;68(1):27-34. Epub 2008 Jan 10.

Reduced mismatch negativity in posttraumatic stress
disorder: a compensatory mechanism for chronic hyperarousal?

Menning H, Renz A, Seifert J, Maercker A.


Department of Psychology, University Zürich, Switzerland,
Binzmühlestr. 14/17, 8050 Zürich, Switzerland.


Mismatch Negativity (MMN) is yet poorly understood in the
context of Posttraumatic Stress Disorder (PTSD, e.g. [Morgan 3rd, C.A.,
Grillon, C., 1999. Abnormal mismatch negativity in women with sexual
assault-related posttraumatic stress disorder. Biol. Psychiatry 45, 827-832.]).
PTSD symptoms like hyperarousal, emotional pressure and avoidance may interfere
with pre-attentive sensory processing. We tested this in an optimized MMN
design [Näätänen, R., Pakarinen, S., Rinne, T., Takegata, R. (2004) The
mismatch negativity (MMN): towards the optimal paradigm. Clin. Neurophysiol.
115: 140-144.] with PTSD victims and a control group without PTSD. A group of
PTSD subjects was compared with gender and age-matched, healthy comparison
subjects without PTSD. A “memory trace” was elicited by frequently
presented “standard” auditory stimuli (50% occurrence) of 1 kHz, 75
ms duration, intermittently with 8 rare “deviants”, which differed in
frequency (higher/lower), intensity (louder/softer), duration (shorter),
direction (left/right) or by the presence of a gap in the sound. During
presentation of tones a silent film was shown. Psychometric data were collected
by SCID, BSI, Attentiveness Inventory, Edinburgh Handedness Questionnaire, and
the PTSD Screening Scale by Breslau et al. [Breslau, N., Peterson, E.L.,
Kessler, R.C., Schultz, L.R. (1999) Short screening scale for DSM-IV posttraumatic
stress disorder. Am. J. Psychiatry 156: 908-911.]. Group comparisons of the MMN
were performed for left/right-frontal/temporal, and for midline electrode
sites. A good differentiation of both groups was found in psychometric and
electrophysiological data. The PTSD group revealed on most BSI scales enhanced
values of psychic aberration. The amplitude of the MMN was significantly
reduced in the PTSD compared to non-PTSD subjects. MMN was significantly
correlated with the total PTSD score. The data suggest a reduction in
pre-attentive auditory sensory memory in PTSD due to specific symptom variables
such as hyperarousal, sleeplessness, impaired concentration and a general
enhanced excitation of the nervous system. This protective inhibition is thought
to be a fine-tuning process in PTSD in order to prevent arousal overload.

PMID: 18262297

Stress. 2011;14(3):233-46. Epub 2011 Feb 6.

The glucocorticoid contribution to obesity.

Spencer SJ, Tilbrook A.


Department of Physiology, Faculty of Medicine, Monash
UniversityMelbourne, Vic., Australia.


Obesity is fast becoming the scourge of our time. It is one
of the biggest causes of death and disease in the industrialized world, and
affects as many as 32% of adults and 17% of children in the USA, considered one
of the world’s fattest nations. It can also cost countries billions of dollars
per annum in direct and indirect care, latest estimates putting the USA bill
for obesity-related costs at $147 billion in 2008. It is becoming clear that
the pathophysiology of obesity is vastly more complicated than the simple
equation of energy in minus energy out. A combination of genetics, sex,
perinatal environment and life-style factors can influence diet and energy
metabolism. In this regard, psychological stress can have significant long-term
impact upon the propensity to gain and maintain weight. In this review, we will
discuss the ability of psychological stress and ultimately glucocorticoids
(GCs) to alter appetite regulation and metabolism. We will specifically focus
on (i) GC regulation of appetite and adiposity, (ii) the apparent sexual
dimorphism in stress effects on obesity and (iii) the ability of early life
stress to programme obesity in the long term.

PMID: 21294656




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