Posttraumatic stress disorder among injured survivors of a terrorist attack. Predictive value of early intrusion and avoidance symptoms.

Fifteen injured survivors of a terrorist attack on a civilian bus were followed during their admission, and 12 of the 14 living survivors were examined 10 months later. A substantial amount of distress was found, in the entire group, across the study. Four patients (33%) suffered from diagnosable PTSD on follow-up. Symptoms of intrusion and denial, recorded during admission, failed to predict PTSD, and were not significantly correlated with psychiatric symptoms on follow-up. This paper discusses the finding of low predictive validity of early PTSD symptoms, and suggests that measures of arousal should be added to those of cognitive symptoms in future prospective studies of traumatic stress.