Unforeseen consequences of terrorism : medically unexplained symptoms in a time of fear.

ONE YEAR later, reports related to the psychological and physiological effects of the terrorist attacks perpetrated on September 11, 2001, continue to emerge. These reports and what little is known about the long-term health effects of terrorism suggest that many people will present to their physicians with medically unexplained symptoms. These symptoms may be mistaken for organic medical diseases, but are likely to be physiological manifestations of psychological distress. This distress stems from living with a heightened state of alertness and harboring a fear of the unknown given that there is now an unpredictable threat that could strike indiscriminately. Previous research examining survivors of terrorism, as well as natural and man-made disasters will be reviewed for it may provide clues as to the possible somatic and psychological costs of terrorism. Further, findings suggest that the negative health effects will reach beyond direct survivors and inhabitants of the New York City metropolitan and Washington, DC, areas and affect Americans across the country. Our observations of patients known to somatize stress are described and suggestions for early detection and treatment are also presented.