In reporting Sunday's story on the emotional toll of the Jan. 8, 2011 mass shooting, I came across a fact that surprised me.

Here's how UA psychologist Patricia Haynes put it: "In  reality very few people actually develop PTSD after traumatic events."

Haynes is an assistant professor of psychiatry, has operated a clinic specializing in trauma and sleep at the local V.A. and is opening a new one at the UA now. She has seen some of the Jan. 8 survivors and explained to me the criteria for diagnosing PTSD according to the DSM IV. (I've copied them at the bottom of this item.)

While I didn't do a study of the Jan. 8 survivors, I interviewed seven and found the number of people with mild and moderate emotional problems to be surprisingly high, while the number with severe problems was relatively low.

Only one person acknowledged having a diagnosis of post-traumatic stress disorder — Ron Barber, Gabrielle Giffords' district director. He's trying to talk about it as much as possible to help lessen the stigma that may be attached to PTSD. I suspect a few others may meet the diagnostic criteria, but probably not many out of the dozens of people who were at the scene.

An interesting 2000 study (attached) by researchers at the Max Planck Institute of Psychiatry in Munich, based on interviews with about 3,000 people, came up with these results:

• 17 percent of those surveyed experienced a serious traumatic event.

• Of those who had experienced a serious traumatic event, 7.8 percent ended up qualifying for a PTSD diagnosis.

I was struck by what Anna Ballis told me. She's the woman who was in a photo on the front page of our Jan. 9, 2011 paper, standing shocked with blood-stained clothes after helping compress Barber's wounds and keep him going till first responders took over.

When I asked Ballis about whether she's had PTSD symptoms, she said "I thank goodness that I have not been through that or been a part of that."

What's helped, she said, is "Talking to the right people. Talking about the incident. Being around and participating in a lot of programs that have  been associated since the Jan. 8 shooting."

"It definitely helps to see other people who were involved."


Here are the diagnostic criteria for post-traumatic stress disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Criterion A: stressor

The person has been exposed to a traumatic event in which both of the following have been present:

   1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

   2. The person's response involved intense fear,helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

Criterion B: intrusive recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

   1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

   2. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content

   3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes,including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.

   4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

   5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Criterion C: avoidant/numbing

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

   1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma

   2. Efforts to avoid activities, places, or people that arouse recollections of the trauma

   3. Inability to recall an important aspect of the trauma

   4. Markedly diminished interest or participation in significant activities

   5. Feeling of detachment or estrangement from others

   6. Restricted range of affect (e.g., unable to have loving feelings)

   7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Criterion D: hyper-arousal

Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:

   1. Difficulty falling or staying asleep

   2. Irritability or outbursts of anger

   3. Difficulty concentrating

   4. Hyper-vigilance

   5. Exaggerated startle response

Criterion E: duration

Duration of the disturbance (symptoms in B, C, and D) is more than one month.

Criterion F: functional significance

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.