Psychiatrists: Colo. shooting witnesses with past trauma, anxiety face added mental health risks

AURORA, Colo. - The Century 16 movie theater is seen where a gunmen attacked movie goers during an early morning screening of the new Batman movie, "The Dark Knight Rises" July 20, 2012 in Aurora, Colorado.

/ Thomas Cooper

(CBS News) Psychiatrists say victims and witnesses of the shooting tragedy at a Colorado theater are likely to experience a stress reaction in the immediate aftermath of the event, but people with a past history of mental illness or a traumatic event face additional risks.

Mass shooting at Batman screening in Aurora, Colo.; At least 12 dead, dozens more wounded
Complete coverage: Colorado Movie Theater Massacre

The violent scene at a Century 16 theater at the Aurora Mall unfolded around 12:30 a.m. local time when a gunman, identified by police as 24-year-old James Holmes, reportedly entered through an emergency exit door and threw two devices that gave off an irritant before opening fire. Twelve people have been killed and dozens more were injured.

"All the witnesses to this horror will be faced with the reliving of this event," says Dr. Victor Fornari, director of child/adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.

He told HealthPop that they may experience anxiety, difficulty sleeping or a heightened startle response, such as if someone opens a door and they jump. This reaction in the aftermath of trauma are called an acute stress reaction.

However, members of the crowd who have experienced a prior traumatic event, such as in military service, may face additional mental health risks, Fornari said.

"One way the mind works, when someone experiences a traumatic event, if they've had earlier traumas, they're bought back," he said.

This can be true even for people who weren't direct witnesses of the shooting but are watching news coverage. An example he used was following 9/11, Holocaust survivors he treated in a Long Island were suddenly afraid of taking a train over safety fears, "rekindling earlier traumas."

He notes the distance between Aurora, Colo. and the site of the 1999 Columbine High School shooting in Littleton, Colo. may bring back past trauma and heightened symptoms for many. The two towns are about 15 miles apart.

"I'd imagine the entire community is reverberating with another tragic sense of this shooting, reliving all these horrors from years ago," he said.

Dr. Alan Manevitz, clinical psychiatrist at Lenox Hill Hospital in N.Y., told HealthPop that the location of the shootings, a movie theater - which has traditionally been considered a safe location - may upend reality for many people. Some may fear going to see the movie, wondering whether it's a one-off incident or there's potential for copycats.

"The only thing you think will go bad [in a movie] is to have a fire and go through the exit door," he said, "and here all the fear comes through the exit, totally turning everything upside."

He referenced New York City Police Department announcing there will be increased security at theaters playing "The Dark Knight Rises" as one such example of reassuring the public's safety.

Given the movie's PG-13 rating, some witnesses of the tragedy may have been children and adolescents, who may display different symptoms of stress than adults.

Manevitz said parents should look out for if their kids are ruminating a lot about the shootings, fixating on their own vulnerabilities or are showing changes in behavior such as separation anxiety or a new onset of fears (such as of the dark). Use that as an opportunity to watch the news with them and discuss the shootings, answering their questions and providing support, Manevitz said.

In addition to prior trauma, witnesses with a history of an anxiety disorder or substance abuse may be more vulnerable to experiencing more severe, potentially longer-lasting effects. Symptoms may include frequently reliving the event, numbness and avoidance of activities, places or people. Children and adolescents may especially be more likely to have aggressive, frightening dreams.

Both psychiatrists say such symptoms should be a flag for loved ones to turn to crisis intervention to get professional help.

"It's very important that you monitor yourself and you're eating right, getting some sleep," said Manevitz. "If you find yourself having any of those symptoms affecting your mood or ability to do your job, you'd certainly need some help."

If people are still experiencing symptoms an acute stress reaction after a month, they may have a more serious problem like post-traumatic stress disorder (PTSD).

The good news, Fornari said, is most people who don't have these prior traumas or mental health conditions have good adaptive coping mechanisms that will allow them to deal with these unspeakable experiences and restore their sense of well-being over time, even if they are startled and anxious during the acute phase of stress.

For the others who may be more symptomatic because of their mental health history, he said there are effective trauma-specific treatments, such as cognitive behavioral therapy, that have been shown effective following high-profile traumatic events such as the Oklahoma City bombing or 9/11. However he does not recommend intervention with a psychiatrist or psychologist for all witnesses of the tragedy.

"In the past there was this sense that debriefing was for everyone," Fornari said. "We've realized more people have coping strategies, so we should only intervene in people who's natural coping mechanisms are not helping them."

[formerlyluvnut]

Oh gawd...the "healthcare" industry is gonna jump on this & capitalize big time.

[formerlyluvnut]

I, BTW, have seen much too much death and maiming from my experiences in Vietnam and as a former Police Officer, and I haven't snapped, nor am I all boo-hooey and help me help me. This stuff gets blown WAY out of proportion by a wimpy society. Yes it's gross and haunting but gawd people, many many people deal with it. It's life.

[shellsmom]

In all do respect to your post there is one thing I need to say. To lose a child is the most horrific thing one can go through. And to lose a child suddenly makes it worse. I lost my daughter, aged 27. Kissed her goodbye before she went surfing and one half later received the dreadful "call" that she drowned. My mind could not accept it. These parents of the young peole who went to the show and never came home will face the same emotional trauma. Until you walk down a path that another has walked down you can never understand what the path was like. This has stirred up a lot of emotions for me. I can only wish the parents STRENGTH for the rest of their lives. We bereaved parent feel their pain and we know the void they will have in their hearts for their entire life. I am in the healthcare industry and when I see parents who have been told their child is dead...the only thing I can capitalize on for the parents, is compassion. No medicine will ever heal the wound, spiritually and emotionally.

[matt6052]

I think they've also had some success with propranolol in PTSD treatment. PTSD victims, when experiencing troubling memories, can have a clear physiological response like increased heart rate.

Propranolol is used to prevent the heart from racing in heart patients. They find that PTSD patients can use the drug to break the pavlovian response between the memory and the panic attack, and that can help them cope with time. They might also use it or other sedatives to prevent the pavlovian stress response from developing in the first place too.

Whatever the case, there will be plenty of resources available help them. As President Clinton likes to say, everyone will be with them tomorrow, and for as many tomorrows as it takes.

[Jaylah54200]

Gee, ya think???

[melpol12]

Mass murderers make headlines, but serial killers do more damage and leave thousands of corpses in their wake. The Red Ripper of Russia strangled and stabbed 58 women and children over a 12 year period until he accidently was caught. The movie house madman will never strike again, but he might have done more damage as a long term serial killer. More police resources should be used to flush out countless serial killers who prowl the American landscape. Mass murderers are more difficult to identify, they are loners who do their evil deeds quickly and are then pacified by anti- psychotic medication.