Terrorism can have significant mental health impacts on both direct victims and the general population. In the immediate aftermath of attacks, stress symptoms are very common but usually decline within a few weeks or months for most people. Direct victims are more likely to develop longer-term conditions like PTSD, depression, or anxiety disorders, with rates around 30-40% within two years. Children and those with prior trauma exposure are also at higher risk. While effects tend to be temporary for most, terrorism can still terrorize thousands or millions of people through fear and uncertainty. Mental health experts need to understand terrorism similarly to how doctors understand physical health threats.

1. TERRORISM AND MENTAL
HEALTH
LET. COL. DR. EHAB ELBAZ
PSYCHIATRY HOSPITAL
MAADI MILITARY MEDICAL COMPLEX

3. DEFINITION OF TERRORISM
• Various legal systems and government agencies
use different definitions of terrorism in their
national legislation.
• The international community has been slow to
formulate a universally agreed, legally binding
definition of this crime.
• These difficulties arise from the fact that the term
"terrorism" is politically and emotionally charged

4. DEFINITION OF TERRORISM
• Terrorism is commonly defined as violent acts
(or the threat of violent acts) intended to
create fear (terror), perpetrated for a religious,
political, or ideological goal, and which
deliberately target or disregard the safety of
non-combatants (e.g., neutral military
personnel or civilians).

5. (2015( ‫االرهابية‬ ‫الكيانات‬ ‫قانون‬
‫الكيان‬‫اإلرهابي‬:
‫أو‬ ‫القانوني‬ ‫شكلها‬ ‫كان‬ ‫أيا‬ ‫التجمعات‬ ‫من‬ ‫غيرها‬ ‫أو‬ ‫الخاليا‬ ‫أو‬ ‫العصابات‬ ‫أو‬ ‫الجماعات‬ ‫أو‬ ‫المنظمات‬ ‫أو‬ ‫الجمعيات‬
‫وءلقراإ‬ ‫ااءرراأ‬ ‫اإ‬ ‫ءير‬ ‫ءلرى‬ ‫الرإالأ‬ ‫رار‬ ‫أو‬ ‫را‬ ‫أا‬ ‫وسريلي‬ ‫يري‬ ‫ب‬ ‫الرةعوأ‬ ‫منهرا‬ ‫الغرر‬ ‫كان‬ ‫أو‬ ‫مارست‬ ‫متى‬ ،‫الواقعي‬
‫رالمواأ‬‫ر‬‫ب‬ ‫أو‬ ‫ري‬‫ر‬ ‫بالإي‬ ‫ررر‬‫ر‬‫الم‬ ‫را‬‫ر‬‫ءلة‬ ‫أو‬ ‫رر‬‫ر‬‫للخض‬ ‫رنهو‬‫ر‬‫أم‬ ‫أو‬ ‫روقهو‬‫ر‬‫ق‬ ‫أو‬ ‫راضهو‬‫ر‬‫ري‬ ‫أو‬ ‫راضهو‬‫ر‬‫ي‬ ‫رريه‬‫ر‬‫ضع‬ ‫أو‬ ،‫رنهو‬‫ر‬‫بي‬ ‫رب‬‫ر‬‫الرع‬
‫أو‬ ‫راني‬‫ر‬‫بالمإر‬ ‫أو‬ ‫رااموا‬‫ر‬‫بر‬ ‫أو‬ ‫ري‬‫ر‬‫الإةرير‬ ‫أو‬ ‫ري‬‫ر‬‫الجوير‬ ‫أو‬ ‫ري‬‫ر‬‫الإرير‬ ‫رالت‬‫ر‬‫المواةر‬ ‫أو‬ ‫ت‬ ‫را‬‫ر‬‫ضصر‬ ‫با‬ ‫أو‬ ‫رار‬‫ر‬‫ر‬ ‫بار‬ ‫أو‬ ‫ري‬‫ر‬‫الضإيعير‬
‫أو‬ ‫رات‬‫ر‬‫الجه‬ ‫أو‬ ‫ري‬‫ر‬‫العام‬ ‫رلضات‬‫ر‬‫الا‬ ‫ري‬‫ر‬‫عرقل‬ ‫أو‬ ‫رل‬‫ر‬‫من‬ ‫أو‬ ‫را‬‫ر‬‫عليه‬ ‫رتيالإ‬‫ر‬‫س‬ ‫ا‬ ‫أو‬ ‫را‬‫ر‬‫تالله‬ ‫ا‬ ‫أو‬ ‫ري‬‫ر‬‫الخاة‬ ‫أو‬ ‫ري‬‫ر‬‫العام‬ ‫راامالا‬‫ر‬‫ب‬
‫ومعاهرة‬ ‫متسارات‬ ‫أو‬ ‫يات‬ ‫الماتار‬ ‫أو‬ ‫العإراأأ‬ ‫أور‬ ‫أو‬ ‫المةليري‬ ‫رةات‬ ‫الو‬ ‫أو‬ ،‫الةكومي‬ ‫مصالح‬ ‫أو‬ ‫القمائيي‬ ‫ات‬ ‫الهي‬
‫والةوليري‬ ‫اإلقليميي‬ ‫ات‬ ‫والهي‬ ‫المنظمات‬ ‫أو‬ ،‫والقنصليي‬ ‫الةبلوماسيي‬ ‫الإعثات‬ ‫أو‬ ،‫العامي‬ ‫المراءق‬ ‫من‬ ‫غيرها‬ ‫أو‬ ،‫العلو‬
‫أو‬ ‫العامي‬ ‫المواةالت‬ ‫ضعضيا‬ ‫أو‬ ،‫مقاومتها‬ ‫أو‬ ‫نااطها‬ ‫أوجه‬ ‫بعه‬ ‫أو‬ ‫لكا‬ ‫ممارستها‬ ‫أو‬ ‫بعملها‬ ‫القيام‬ ‫من‬ ‫مصر‬ ‫ءى‬
‫وسريلي‬ ‫يري‬ ‫ب‬ ‫الرةعوأ‬ ‫منهرا‬ ‫الغر‬ ‫كان‬ ‫أو‬ ،‫كانت‬ ‫وسيلي‬ ‫يي‬ ‫ب‬ ‫للخضر‬ ‫ضعريمها‬ ‫أو‬ ‫سيرها‬ ‫عرقلي‬ ‫أو‬ ‫منل‬ ‫أو‬ ‫الخاةي‬
‫او‬ ‫الةسرتور‬ ‫كرام‬ ‫أ‬ ‫ضعضيرا‬ ‫أو‬ ‫للخضرر‬ ‫أمتره‬ ‫أو‬ ‫مصرالةه‬ ‫أو‬ ‫المجتمرل‬ ‫سرالمي‬ ‫ضعرريه‬ ‫أو‬ ‫العام‬ ‫بالنظام‬ ‫ال‬ ‫اإل‬ ‫ءلى‬
‫الةريري‬ ‫علرى‬ ‫عترةاإ‬ ‫ا‬ ‫أو‬ ،‫أعمالهرا‬ ‫ممارسري‬ ‫من‬ ‫العامي‬ ‫الالضات‬ ‫ةى‬ ‫ء‬ ‫أو‬ ‫الةولي‬ ‫متساات‬ ‫ةى‬ ‫ء‬ ‫منل‬ ‫أو‬ ‫القوانين‬
‫رةأ‬ ‫بالو‬ ‫اإلبررار‬ ‫أو‬ ،‫والقرانون‬ ‫الةسرتور‬ ‫لهرا‬ ‫ك‬ ‫التري‬ ‫العامري‬ ‫والةقو‬ ‫الةريات‬ ‫من‬ ‫غيرها‬ ‫أو‬ ‫للمواطن‬ ‫الاخصيي‬
‫القومي‬ ‫اامن‬ ‫أو‬ ‫جتماعي‬ ‫ا‬ ‫الاالم‬ ‫أو‬ ‫الوطنيي‬.

6. ONE MAN`S
TERRORIST IS
ANOTHER`S FREEDOM
FIGHTER

7. EARLY HISTORY OF TERRORISM
• ZEALOTS (1st century )
• ASSASSINS (11th century )
• FRENCH REVOLUTION (1789)

10. “Kill one to terrorize ten thousand.”
4th century B.C
Sun Tzu

11. MENTAL HEALTH OF THE GENERAL
POPULATION FOLLOWING TERRORIST ATTACKS
• Within the first month after the 11 September 2001
attacks, symptoms of stress were evident in individuals
geographically far distant from the original incident, and
nationally depressive symptoms in the USA rose for 4
weeks only to fall back to previous levels thereafter
(Knudsen et al, 2005).
• Rates of substantial stress are extremely high in the first
few days after the incident but are already in decline in the
first 2 weeks and by 6–8 weeks have fallen by two-thirds.
Thus for the majority of individuals significant stress
symptoms are temporary and are unlikely to have lasting
mental health implications ( Vázquez et al, 2006).

12. MENTAL HEALTH OF THE GENERAL
POPULATION FOLLOWING TERRORIST ATTACKS
• Rates of PTSD in the general population attributable to
single attacks may be as high as 11–13% in the first 6
weeks but decline sharply with time, with most studies
indicating rates below 3% 2 months after the incident.
• Those reporting more symptoms will include members
of minority groups (Schuster et al, 2001; Galea et al,
2002; Rubin et al, 2005), people with previous
experience of adversity (Galea et al, 2002, 2003) and
people who have developed psychiatric disorders in
response to past stresses (DeLisi et al, 2003)

13. CHILDREN
• Close to 1 year after the bombing of the Alfred P.
Murrah Federal Building in Oklahoma City, about
5% of elementary schoolchildren reported
clinically significant levels of symptoms of PTSD
(Gurwitch et al, 2002).
• In New York City itself, 6 months later Hoven et al
(2005) reported that 28.6% of children had at
least one probable anxiety/depressive disorder,
the most common being agoraphobia (14.8%),
separation anxiety (12.3%) and PTSD (10.6%).

14. MENTAL HEALTH OF DIRECT VICTIMS
• PTSD appears to be the most common disorder
attributable to the attack, followed by depression
(North et al, 1999; Miguel-Tobal et al, 2005),
although other sequelae include traumatic grief,
panic, phobias, generalised anxiety disorder and
substance misuse
• There is remarkable uniformity that within 2
years of the incident 30–40% of the people
closest to the site of the attack are likely to
develop a clinically diagnosable disorder.

15. CHILDREN
• Elbedour et al (1999) found that 50% 0of the
daughters and 23.1% of the sons of those
killed in the Hebron massacre were suffering
from probable PTSD.
• Children were more likely to experience post-
traumatic symptoms following the Oklahoma
City bombing if they had been bereaved
(Pfefferbaum et al, 1999).

16. BELTWAY SNIPERS
)2002October24-02(Washington DC region,
Copyright 2005-2014
Michael A. Bozarth, Ph.D.
10
Killed
3
physically injured
100’s psychologically ‘injured’
100,000’s terrorized
Photo from Gwww.azette.net
Photo from www.FBI.gov

17. TOKYO SUBWAY ATTACK
)1995March20cult,kyo-ShinriAumgas attack bySarin(
Copyright 2005-2014
Michael A. Bozarth, Ph.D.
12
Killed
5,700
physically injured
9,000+ psychologically ‘injured’
10,000’s terrorized
Photo from www.ait.org.tw
Photo from www.tofugu.com

18. ATTACK ON AMERICA
)2001September11(World Trade Center & Pentagon,
Copyright 2005-2014
Michael A. Bozarth, Ph.D.
3,025
Killed
1,000’s
physically injured
10,000+ psychologically ‘injured’
A nation terrorized

19. CONCLUSION
• Terrorism is a weapon
• Mental health professionals have to study
terrorism , like surgeons studying firearm
injuries