‘I’m laughing and joking,because if not,I would be crying’: Exploring the impact of terrorist attacks on direct victims

Abstract

Prior studies examining victims of terrorist attacks often focus on clinical outcomes, on vicarious victims, survey a broad area that was impacted by a terrorist attack, or only focus on one terrorist attack event. Findings from these studies indicate that victims are often impacted psychologically and behaviorally. While much has been gained from this research to support victims in the aftermath of a terrorist attack, there is limited research on the overall impact on individuals from different types of attacks, in varied locations, and if there are commonalities to individual impacts from terrorism attacks more broadly across victims. To bridge this gap, the current study uses qualitative data from in-depth life history narrative interviews with 22 terrorist attack victims from an international sample of attacks to explore the impact of this specific form of victimization. In doing so, we begin teasing out commonalities and differences of the impact of victimization from seemingly unrelated backgrounds. The findings have implications for policy for victims of terrorist attacks domestically and internationally.

Keywords

Terrorist attack terrorist attack victimization qualitative methods impacts

Introduction

Terrorism has made a global impact, attempting to spread fear into populations everywhere. After terrorist events, government officials often propose new counterterrorism policies, make public statements about the social and community impact, and offer financial assistance and support to families of casualties. Despite attempts at community unification and support, these attacks leave many of the surviving victims feeling forgotten. An issue with addressing responses to terrorist attacks is that there are multiple types of victims or labels that can be applied to victims of terrorism, including direct, indirect, vicarious, and bereaved. Responses to attacks often focus on victims with significant physical injuries, casualties, and families of casualties (bereaved), and overlook many of the individuals who may have had direct exposure to the attack, but for them it did not result in physical injuries. Furthermore, much of the research on victims of terrorist attacks has focused on either clinical outcomes (depression, post-traumatic stress disorder (PTSD), substance use), only focused on one location or event, or examined indirect or vicarious victims (Desivilya et al., 1996; Greiger et al., 2003; Luhmann and Bleidorn, 2017; Sabir and Aslam, 2011). While there is debate over how victims are defined and categorized, even among victims (or as some would call themselves, survivors), the present study follows the distinction made by Shamai and Ron (2009) who examined physical and psychological responses to attacks in relation to level of exposure, and differentiate between direct exposure and ‘indirect exposure through physical proximity to the event; being close to someone who was killed, injured; or directly exposed to the attack’ (p. 3), and the classification system designed after the Oklahoma City bombing (1995), where countless lives were impacted directly and indirectly, and individuals were tasked with designing a systematic method to label people so that they could be appropriately accounted for, compensated, or included in various post-attack memorials or meetings. The present study examines the issue of impact from a direct victim perspective, defined here as an individual or group who were specifically targeted for violence, or who were in the physical location of a place that was explicitly targeted, or who were directly exposed to the attack.

Due to the oftentimes muddied process of designating labels to victims after an attack, direct victims often remain poorly understood, misrepresented, and undercompensated. These victim groups are made up of many who have lost their own sense of self, safety, and security and are possibly plagued with both physical and psychological losses, such as a feeling of a total loss of control (Burgess and Holmstrom, 1979, Ten Boom and Kuijpers, 2012). The long-term psychosocial impact can not only influence the victim’s behavior and mental health but also affect their way of life and disrupt many relationships (Bolton et al., 2004). A victim’s response to such trauma may differ depending on the strength of their support groups and their own coping abilities. Lasky et al. (2017) noted that victimization has a range of effects on physical health, psychological well-being, and practical concerns that all victims undergo. Social support structures, therapy, and proper representation are key areas of need in serving those who have suffered. Commonly, victimization research is marginalized in the hierarchy of criminologists’ attention (Pratt and Turanovic, 2016). Therefore, the present study aims to expand the literature by utilizing life history narratives of direct victims of terrorist attacks to address the impact of this specific form of violence on an individual, examine the impact of direct victimization using an international population spanning multiple types and locations of terrorist attacks, and provide a base of knowledge for policy-makers to provide evidence-based decisions and resources for individuals in the aftermath of this form of violence.

Changes in mental and behavioral patterns

Direct victims of terrorist attacks have experienced a traumatic event psychologically, physically, or both. Once the attention shifts from the attack to counterterror responses, memorials, or repairing city blocks or property, many victims feel disregarded or feel they may never find closure but are still left with emotional and mental trauma. Early research confirmed the major psychological impact of ‘intentional disasters on communities and individuals’, resulting in the multi-stage long-term mental health services plan following the Oklahoma City bombing in 1995 (United States. Office of Justice Programs. Office for Victims of Crime, 2000). Paz Garcia-Vera and colleagues (Paz Garcia-Vera et al., 2016: 2) further suggest that, ‘The psychopathological repercussions of terrorist attacks go beyond the people who have experienced the attack directly and who have survived it without harm or with varying degrees of injuries’. Victims may experience erosion of trust and autonomy in strangers, transportation systems, or even everyday living (Bard and Sangrey, 1986; Spilerman and Stecklov, 2009), and it is common that many victims will have a sense of decreased safety, which in turn leads to long-term effects on their emotional and psychological health (Grieger et al., 2003). Since the events of 11 September 2001, research on the psychological impact of terrorism has increased in volume. Some of the most significant findings about the effects of terrorist attacks on victims include fear that they or someone they love will fall victim to future terror attacks, a feeling of lack of security, lack of confidence in institutions, and generalized fear and anxiety (Grieger et al., 2003). Victims often experience nightmares, phobic reactions, and guilt over how their deaths might have been avoided, also known as survivor’s guilt (Nader, 2001). Recent research examining the effects on victims of terror attacks has shown that trauma-related shame often accompanies survivor’s guilt. In a study examining trauma-related shame and guilt after a terror attack, Glad et al. (2024) found that survivors predominantly felt shame associated with being worried about what other people might think about them after the attack and worrying about what they could have done differently during the attack. Due to the highly public nature of terror attacks, victims are potentially exposed to public scrutiny, resulting in self-blame and questioning of their actions during the attack.

Research also shows an association between a victim’s dissociative symptoms, numbness, and anxiety having a greater risk of the person developing PTSD (Grieger et al., 2003). Grieger et al. (2003) found that many victims used alcohol as a primary care intervention after experiencing a terrorist attack or traumatic event. Increased rates of excessive alcohol use were found among persons with PTSD at the period of 7 months. Similarly, Galea and Resnick (2002) found that the rate of alcohol consumption increased in victims with PTSD weeks after the 11 September attacks, which may suggest that in the aftereffects of a terrorist attack, alcohol is frequently used as a coping device. Prolonged use of alcohol as a coping mechanism can lead to substance abuse disorders and prolong emotional healing (Eliashar et al., 2024). Furthermore, a study by Bjørgo and Jupskås (2021) addressed the impact on victims’ mental health after the Utøya, Norway attack in 2011. The authors found that the attack had several repercussions for the survivors, as it affected their mental health for years after the attack, including symptoms of post-traumatic stress, depression, increased vigilance, and guilt. Consequently, victims of terrorist attacks may avoid similar target locations in the future to reduce vulnerability or the potential for another attack, engaging in their own crime prevention strategies to counter terrorism (Parkin, 2015).

After a violent victimization, some victims exhibit an initial reaction of temporary paralysis, denial, and regressive behaviors and question what they could have done to prevent it (Steele, 2018). It is not uncommon for victims to become more vigilant and adopt avoidance strategies to help them cope; however, most avoidance behaviors, such as staying home behind locked doors, do little to reduce fears of being victimized again (Rader et al., 2007). Regardless, avoidance strategies appear to be an instinctive reaction for direct and indirect victims of terror attacks. A study examining the social impact of 9/11 on New York City revealed more than one-third of adults preferred to stay home or not go to work, and 43% of parents reported cutting back on their children’s freedoms to travel around the city (Foner, 2005).

Oftentimes, victims will alter their daily patterns to avoid being in the same location as their attack spot and change their routines (Peek, 2003). Coping and dealing with stressors is no longer an easy task, but a challenge that must be overcome. After major events such as 9/11 and the Oklahoma City bombing, it has been noted that victims or people exposed to the attack changed their behavior to reduce their potential exposure to future attacks (Huddy et al., 2002: 7), similar to the way victims of other terrorist attacks respond behaviorally because they feel a need or desire to take extreme measures to prevent being in a victim population again (Spilerman and Stecklov, 2009). In addition, survivors of the 2004 attacks in Madrid demonstrated other avoidance behaviors such as repressing memories of the incident and avoiding any reference to the attack (Miguel-Tobal et al., 2005).

The personal hardships victims face can make them short-tempered, nervous, edgy, depressed, or struggle with concentration (Huddy et al., 2002: 22), which can affect other areas of the victims’ life, like work, school, or leisure activities (Hindelang et al., 1978). While personal behavior is relevant, the outward behavior extends to family, friends, and overall personality. After an attack, victims can become overly cautious not only in terms of settings they choose or choose not to insert themselves in, but the way they conduct everyday procedures. Following 9/11, victims were weary of air travel, experienced heightened anxiety, and would go to great lengths to deploy their own counter terrorism methods, separate from what society or the government implemented (Nacos, 2019). In places where the vulnerability of experiencing a suicide bombing is heightened, people will completely avoid going out in public. One study indicated that citizens will avoid public places such as markets, mosques, and sports events, and may never return to those locations again (Rathore, 2011). Other research indicates that the behavioral impact may be higher in countries with continuous political or economic strife. In Western and Middle Eastern societies, attitudes toward socialization drastically change following an attack and can impact individuals for their remainder of their life (Vergani et al., 2018: 157).

Vergani et al. (2018) found that a major factor underlying behavioral changes is a loss of trust. The ability to trust people, places, and public transport impacts many victims of terrorist attacks because the innate belief to think of strangers as trustworthy is gone and replaced with fear. Vergani further notes that events that look like or are similar to terrorist attacks can remind people of their mortality, which can have a powerful subliminal impact on human beings, unconsciously prompting a behavioral shift (Vergani et al., 2018: 20). Constantly being reminded of a near-death or life-threatening experience changes the way people socialize and act in group settings because their autonomic reactions of fight or flight are heightened, causing increased arousal patterns and the feeling of being on alert. Once the social bonds of trust have been broken, victims may find it difficult to open up to others and move on from the experience (Nijenhuis et al., 2010).

Post-attack complications and growth

Direct victims of terrorist attacks may experience significant lifestyle changes after the attack. Physical injuries acquired from the attack can impact daily activities both short and long term. A study comparing the rehabilitation outcomes for terror victims with multiple traumas with the outcomes for patients with non-terror-related multiple traumas revealed that victims of terror spent longer periods in rehabilitation than non-terror groups; however, they regained most activity in relation to daily functions similar to the non-terror group (Bugge et al., 2017). Depending on the type of attack, victims’ injuries can be more or less impairing. One study found that many survivors who had sustained severe injuries revealed poorer long-term adjustments and more distress than their counterparts who had been less victimized or not physically injured (Desivilya et al., 1996). Desivilya et al. (1996) found that victims who are not wounded have no physical reminders of the traumatic event that they experienced and faced fewer adaptational difficulties. Contrarily, those victims who had been gravely injured were affected far more in the later stages of their lives, their injuries acting as a constant reminder of the hardships they had endured. Desivilya et al. (1996) highlight that the duration of the traumatic experience and the degree of physical injury experienced have a role in the victim’s ability to become well-adjusted in the later stages of their lives. Without proper care and treatment, injuries can be life-threatening or deadly. Preparedness for emergency responders is pivotal but can vary based on the region, attack, and attack method (Tin et al., 2021).

Changes following a terror attack are not always negative. Victims of terror attacks may also navigate toward positive coping strategies, such as changing careers to help others or becoming involved in victim advocacy. In addition, many victims of terror attacks seek out support by participating in support groups. The benefit of peer support between victims of terror attacks, whether it be from the same attack or different attacks, is highly effective. Social support has been identified as the single most powerful protective factor for trauma victim connectedness (Norris and Stevens, 2007).

Recent research has shifted its focus to the positive growth a person may experience after a period of struggle or trauma, known as post-traumatic growth (PTG) (Taku et al., 2021). PTG has aided numerous clinicians in better understanding victims and how they cope with distressing and traumatic experiences. According to Silver and Wortman (1980), by successfully coping with victimization it can serve as a growth-promoting experience for victims. Victims adopt different coping strategies after a traumatic event, and within as quickly as a few days, there can be significant short-term emotional reactions and changes in behavior in pro-social directions (Collier, 2016). Tedeschi and Calhoun (2004) were able to measure these different reactions and a victim’s long-term emotional and behavioral growth through the use of the Post-Traumatic Growth Inventory (PTGI) scale, examining five areas—appreciation of life, relationships with others, new possibilities in life, personal strength, and spiritual change—and further state that openness to experience and extraversion are key components in victims who experience PTG (Collier, 2016). Tedeschi and Calhoun (1996) states this is because, ‘people who are more open are more likely to reconsider their belief systems and extroverts are more likely to be more active in response to trauma and seek out connections with others’. Earlier research by Friedman et al. (1982) reported similar findings that showed the more supporters victims had, the sooner they got over the post-traumatic stress of victimization.

Farfel et al. (2008) analyzed data from the general population on those victims impacted from the 11 September 2001 (9/11) terrorist attacks. The data showed an association that certain demographic characteristics, like the gender of the victim being a woman, put them at a higher risk of developing PTSD even after controlling for other factors (Farfal et al., 2008). Gender-specific emotional responses to trauma are not the only variables that deserve more in-depth mental health monitoring. According to Murphy and Poynting (2010) and Norris et al. (2005) women and girls showed more symptoms of PTSD, depression, anxiety, fear of non-specific disaster and health problems than men and boys. Farooqi and Habib (2010) substantiate this claim through their findings that detail significant differences in levels of anxiety, depression and stress reported by survivors of different gender, with females reporting higher rates compared to their male counterparts.

Alternatives for victims following an attack can range from seeking medical or psychological treatment. These and closely monitoring physical or mental injuries can all result in lifelong treatment. Quantitative research has shown that out of 512 participants, 48 suffered from PTSD, 1 suffered from acute stress disorder, and 299 reported receiving medical treatment for depression (Hussain et al., 2012: 2). However, further research has indicated that victims with physical injuries exhibit higher levels of mental distress such as PTSD, demanding medical attention (Wiseman et al., 2013). Although victims with physical injuries are more likely to receive medical treatment, the behavioral aspect of anxiety can negatively affect overall health, and in some cases the post-attack period can be worse than the attack itself. One researcher suggests that, ‘In the end, lifestyle afflictions like alcoholism, drug abuse, chronic anxiety, and fatalism have posed a much greater threat to health, and essentially have killed far more people, than exposure to Chernobyl’s radiation’ (Mueller, 2007: 7), signifying the limitations of research and resources currently available for victims.

The present study

Prior research suggests that victims of terrorist attacks often experience psychosomatic ailments, specifically high levels of PTSD and anxiety, and exhibit behavioral changes, commonly increased vigilance, reflecting a need to feel safe, secure, and in control. Research has also demonstrated changes in lifestyle and the potential for growth in the aftermath of trauma and victimization. Yet researchers have not examined the connections between these areas of victimization impact on a broad level, with a diverse sample of terrorist victimizations, and across the life history of the victims. As such, this study has several guiding questions: What are the victims’ experiences and perceptions of the support or lack thereof they received during and after the terrorist attack? Have the victims’ activities or lifestyle been impacted since the attack? Has the victim engaged in any behavioral changes since the attack? Finally, what do victims perceive as being the most helpful in overcoming the experience of a terrorist victimization?

Methods and data

A total of 24 participants were recruited through snowball sampling from December 2021 to May 2022. This study received ethical approval from the Flagler College Institutional Review Board (IRB) (approval #1129201) on 1 December 2021 after a full board review. The principal investigator completed institutionally mandated ethics training for qualitative research with victims. Respondents gave written consent for review and signature, followed by verbal confirmation, before starting interviews.

Following IRB approval, potential participants were suggested via a gatekeeper and sent an initial email asking if they would like to participate in a study about their experiences, and if so, to respond directly to the principal investigator. Each individual who contacted the research team about potential participation was asked in what way they were impacted by a terrorist attack (direct, indirect, bereaved) and what event impacted them. The study follows the Global Terrorism Database definition of a terrorist attack as, ‘The threatened or actual use of illegal force and violence by a non-state actor to attain a political, economic, religious, or social goal through fear, coercion, or intimidation’ (GTD, 2025). If a person self-identified as a direct survivor/victim and was interested in participating, they received and signed a consent form. Interviews were scheduled primarily by zoom video. Two participants who were bereaved were not included in the present study. For two interviewees who did not speak English, a translator was provided in French. Participants did not receive any compensation, but many expressed a willingness to participate to ‘help anyone with a similar experience’.

A semi-structured life history interview protocol was developed and peer-reviewed by outside academics in the field. In the current study, life history interviewing was selected as the primary (and optimal) means for acquiring conversational data for addressing the research aims. By inquiring about their life story, participants were able to ‘convey to themselves and to others who they are now, how they came to be, and where they think their lives may headed in the future’ (McAdams and McLean, 2013: 233), which aligns with examining a person’s experiences before, during, and after a terrorist attack victimization. Participants were asked questions about specific time periods to assist with memory recall since extended periods of time may have passed, which allows the opportunity for reflection on changes over time and how the individual addressed various life events. The interview protocol was additionally submitted to the project gatekeeper and another direct survivor to provide feedback and recommendations on the nature of the questions and language utilized. As victims are a vulnerable population, and the subject matter potentially emotionally activating, it was important to frame questions in a way that would provide an open and safe space for victims to discuss their experiences in a candid manner, while limiting triggering language to the best of the researcher’s ability. Interviews lasted approximately 90 minutes to 2 hours and were recorded with each participant’s permission, later transcribed, identifying personal information was redacted, and recordings were deleted.

Privacy was very important to some of the participants, as they expressed fear of potential repercussions from what they said, or because they wanted to feel comfortable expressing feelings or stating experiences they do not often share. As one victim stated, ‘I’ve never said this to anyone . . .’. As such, the confidentiality of the victims and their statements was a priority. After all life history interviews were transcribed, each was coded by multiple members of the research team for consistency, reliability, and thematic development. Given that the participants come from various backgrounds, places, and victimizations, their experiences were compared to look for commonalities and differences, which were captured to provide evidence of similarities in terrorist victimization experiences and nuanced differences within this population.

Sample characteristics

Analysis for the present study consisted of 22 life history interviews out of the full dataset of 24 participants. Participants were mostly female (n = 14) and ranged in age from 26 to 78 years (mean age = 50 years old). Participants were mostly from Europe (n = 8) or the United States (n = 12), with two participants from Africa, whereas where the attack took place is more diverse (n = 5 occurring in Africa, n = 7 occurring in Europe, n = 2 in the Middle East, and n = 8 in North America). Six participants were on trips abroad when they experienced the terrorist attack. Four of the participants were victims of targeted terrorist attacks (specifically attacked because of personal characteristics, such as religion); six participants were victims of an armed assault, while the majority of participants were victims of bombings. Five individuals were with their family at the time of the attack, while most of the sample were with friends, work colleagues, or in a group of unknown people. More than half of the sample did not have a physical injury from the attack, while eight participants had varying degrees of physical injury (i.e. from shrapnel to the loss of a limb).

Findings

Participants in this study commonly discussed a variety of ways the attack impacted their life due to the victimization. A common statement by a large majority of the sample was that they felt that their voice was not heard after the attack, they were not listened to, and they were not validated in their experiences or feelings for a long time. Thus, the findings are presented in a way that allows a platform for the victims to express their unique experiences in their own voices on how a terrorist attack directly impacted them and their life. The area for which victims expressed the most impact was mental health, which affected other areas of their life more broadly. Issues with PTSD, anxiety, and depression overshadowed many behavioral and lifestyle changes experienced by each participant; however, individuals who sustained physical injuries demonstrated greater levels of PTG.

Mental health consequences overshadow daily living

Most of the sample (n = 19) self-reported one or more clinical psychosomatic diagnoses related to their victimization experience. The most common diagnosis was PTSD (n = 16), but anxiety, depression, and obsessive compulsive disorder (OCD) were also stated. The following individuals describe how the victimization impacted their mental health:

And to tell you the truth, in the first six months after the attack we, I had so much PTSD, our youngest wouldn’t leave the house, he was afraid to be shot. Our eldest spent the first month just lying in bed looking into a wall and then he had a massive substance abuse afterwards, only 14 years old, so we kind of also engulfed our lives in other things you know. We had to kind of deal with the aftermath of it all. (Female, Armed Assault, Denmark)

Since the bombing I have worked a lot on my my own mental health, and I know kind of how to deal with it now, you know kind of just shut it down if I need to or just let it roll over me because I know it’s not me. I started therapy a week later. Walking away developing PTSD, you know, a few months later that’s a that has a real impact on my life and my physical health. (Female, Bombing, United States)

A large number of individuals from the sample experienced feeling forgotten or lonely (n = 16) but stated that receiving validation of feelings and experiences reduces feeling forgotten or isolated, and this was a key part of moving forward. As these participants describe:

My whole experience has been feeling unseen which has led to my wanting to do advocacy work and trying to you know, make sure the memorial was inclusive. (Female, Bombing, USA)

I remember the doctor like he did all these things, and he sat me down and he told me exactly what happened, how it happened, why I have what’s going on and I literally just like cried in his office because this is the first doctor that’s validating, and I’m a doctor you know, and so I’m finally getting validated for like an explanation. (Male, Bombing, USA)

Almost the entire sample of participants (n = 19) experienced triggers immediately following the attack or since the attack, while some have lessened over time. Triggers generally fell into one of three primary trigger types, with fear-related triggers being the most common (n = 12), followed by insecurity (n = 8), and violence or violent images (n = 5). As these individuals describe:

If I see a particular shooting or a bombing somewhere, anywhere else, I immediately, that triggers to me to start thinking, in my thinking process, oh, what are those people going to do, how are they going to deal with it? (Male, Bombing, United States)

In the immediate days and weeks, even months, I didn’t leave my dorm. I built a cocoon. I told you, I had a locker to keep all my clothes in, the locker was next to my bed, and I put a rod across and I hung my sheets and I built myself a little cocoon for the first two weeks and I didn’t come out . . . I stayed in Israel for three years because my fear, and it was very conscious, was that if I left, I would never go back. I wouldn’t be able to face it, because that was that would be my memory of Israel, and that would be my, you know, that this is a bad place. (Female, Suicide Bombing, Israel)

Triggers were often linked to situations where the person feels a lack of security, distrust, or the potential for further victimization. Males were more likely to have triggers related to feelings of insecurity and females more often experienced triggers linked to fear of victimization, even though there was an overlap of trigger type among male and female participants. As these participants state:

My anxiety, and everything starts the first, second weekend in August, it’s like clockwork. My wife, my wife knows to stay away from me, because you can poke me 1,000 times during the year like this and I’m not going to say anything if you do that. Once in August, and I’m going to rip your head off because it’s just that time of year when everything kind of just kind of comes together for me. (Male, Hijacking, United States)

I suddenly found I was having like, I don’t think it was a panic attack, I literally like I I just started to panic, like and had to calm myself down, it was just it was like I went back there like it was packed but had my children with me. I was just like I’ve never really wanted to bring my children on the tube before, just like I know nothing’s going to happen like again, but that big fear of it and I suddenly just panicked. (Female, Bombing, England)

Just over half the sample stated they faced adverse or traumatic situations early in life and before the terrorist attack victimization. Those with traumatic experiences before the attack who were physically injured by the attack exhibited traits of PTG after the terrorist attack victimization. These individuals describe various areas of growth:

Basically, after my injuries, I became a spokesperson for most of the injured that have invisible injuries. I do remember wanting to help. (Male, Bombing, USA)

In general, I mean I had to readjust my life definitely because I’ve got a prosthetic leg now and I’ve got stairs in my house and little things like that so I have to make minor adjustments. Things I could have done before I’m not doing anymore, but other than that I think I cope pretty well . . . I find it, I’ll find beauty, I’ll take a little walk in nature, I do a lot of meditating . . . It happened to me for a reason, it made me the person I am today. (Male, Suicide bombing, England)

A common factor among participants was feelings of survivor’s guilt (n = 9). Those experiencing survivors’ guilt, those unable to overcome the feeling of guilt, or those with a long-term experience of guilt were more likely to report negative life satisfaction. As these participants described:

You know, guilt, it’s one of those things that apparently a lot of people who go through these kinds of events, it’s a guilt, you feel guilty because you made it out, which I did. I mean the average age of those killed was 26 when I was 61. How does that make any sense? People just starting out in life and they get killed and I’m walking around. (Male, Bombing, London)

I had no one helping from the city or the state explaining why, how, helping me process these feelings of guilt. I felt guilty. On top of all the mental and physical pain and anguish I was in, I had all this guilt every day. (Female, Bombing, United States)

Victims alter their behavior to be more security conscious

Participants experienced overall negative behavioral changes, but there were some positives as well (n = 7 expressed some positive impacts). Five stated that they moved following the terrorist attack and they did so because of the attack. Of those who moved, the primary reasons included feeling isolated, mental health, not feeling safe, security, and the politics of where they were. The following individual described her negative experience and why she decided to move:

As a terrorist survivor I felt very isolated in Britain and that the way the politicians navigate the landscape, they try to sweep the topic under the carpet. And that creates the situation that the survivor of terror attack feels very isolated. That one thing is, that not many people understand or would even know how to talk about or even start at the subject. (Female, Shooting, Denmark)

Most individuals engaged in avoidant behavior after the victimization experience. When asked the question, ‘Is there anything that you avoid now that you didn’t before?’ Sixteen participants stated, ‘yes’. For these individuals, returning to the location of the attack was challenging, especially those with mental health issues only and no physical injuries. The following individuals describe their avoidant behaviors:

And yeah it was like going back to work, I didn’t go on the tube for a long time, I took a bus and, I can do the tube now like I can, I don’t really want to do but I’ll do it . . . But I know it’s different time and place etc . . . Going into crowds was a big one and seeing bags left and smelling smoke. Then there was this bag left on a seat in Leicester Square and I literally just had a panic attack. (Female, Suicide bombing, England).

You know I still today wouldn’t really want to go into like an enclosed indoor mall, like outdoor malls are more comfortable going into. I would avoid a lot of public spaces for a long time . . . I would still do it, but always feel like on edge, and still kind of nervous. I tell myself I can never go in a mall. (Female, Armed Assault, Kenya)

Several people said they forced themselves to return to the location immediately after, providing reasons such as, ‘conquer your fears’, ‘if I left, I would never go back’, and ‘I don’t want to be afraid’, while a few people pushed themselves for work reasons.

Furthermore, participants expressed avoidant behaviors of places they considered vulnerable for attacks as well, which manifested as increases in behaviors related to safety and security, seen through increased vigilance, an increase in preventive measures, and self-protective behaviors. While not all individuals in the sample engaged in each of these behaviors (and some stated they did not engage in any of them), about a quarter of the sample engaged in all three behaviors together, with an overlap between this group of participants and those who stated they engaged in avoidant behavior as well. One participant highlights these increased safety and security measures:

I did, which was why I think, why I became so keen to become involved directly involved with other people’s crisis, whether they were small or significant, the idea of looking out for other people really hammered in the event, hammered into me the significance of distress.

And so my underlying goal always was to prevent or minimize other people’s distress as a consequence of the distress that I had felt both before the event, during, and after the event, it was sort of a whole awful cocktail of guilt and the trauma. So, if anything, immediately after the event, I was far more alert to other people’s distress and more driven to do something about it.

I have learned some pretty advanced first aid, I volunteered as an emergency responder with the Red Cross in recent year . . . that event did certainly push me towards always thinking and trying to be prepared for the worst. (Male, Suicide bombing, UK)

Terrorist attacks alter careers, hobbies, and leisure activities of victims

Consistent with Hindelang et al.’s (1978) definition of ‘lifestyle’ as what people spend their time doing, participants expressed three primary areas in their lifestyles that were affected after the terrorist attack, the biggest being career changes, followed by hobbies they engaged in, and alcohol and drug use (given that participants spoke of increased substance use in the context of a social occasion or with other people, for this study, it is classified as a social or leisure activity).

Only three participants expressed no change in their career after the victimization, while some participants engaged in career changes for non-victimization-related reasons (i.e. maternity leave, time, money, retired). Of those who did experience a change in career, the most common reason was for mental health (n = 9). Many of these participants increased work in areas related to terrorism, victim advocacy, and helping others and expressed an increase in this line of work as a way to distract themselves, focus on something else, for ‘therapeutic’ purposes, or to feel useful. As these participants said:

I became an advocate after this and I talked about my story, and I, you know fought the city, to make sure all survivors were included. My whole experience has been feeling unseen, which has led to my wanting to do advocacy work and trying to you know, make sure the memorial was inclusive and all of this stuff . . . So it was empowering to share my story. (Female, Bombing, United States)

AWLL: So I’ve been in fitness three years. Previously to that I was in events. JG: What got you into that switch? AWLL: Mental health, basically, I used exercise to get me out of a rut and then I decided that I wanted to do that for others, so I became a personal trainer. (Female, Suicide Bombing, England)

Two participants changed careers due to physical injury from the victimization. One was no longer able to work, and the other stated their injuries led them to wanting to help others who feel similarly. The latter individual described:

Well, I used to have a private practice prior to the bombing. So at the event time I was in a very thriving medical practice with nurse practitioners, and I think that’s an important thing that definitely changed things . . . And then I changed gears to what I’m doing in medicine and that’s why I’m doing what I’m doing working for nonprofit. (Male, Bombing, United States)

A related area to career changes, three participants changed aspects of their education, two individuals pursued further education to advance themselves in the new direction that their life was going for mental health and experiential reasons, while one participant dropped out of school for mental health reasons.

I feel like my degree was sort of like an F you to the terrorists . . . I did do that degree not because professionally I need a degree, but I wanna do it to help me to be better in the role outside of my professional career of working with victims and working with other countries. (Female, Suicide Bombing, Israel)

About half of the participants expressed changes in their hobbies and leisure activities as a direct result of the terrorist attack experience (non-related reasons for change include aging out, other priorities, being a workaholic, and several expressed still engaging in the same activities as before). All participants stated they became active in various support groups. Half the sample stated that support groups had a high impact on their lives, and they were very involved in them, spending time organizing group events, attending memorials for their event and other events, and being actively engaged with the group in person and on social media. Two participants stated that engaging in support groups had a low or no impact on them, and one participant stated that participation in support groups had a negative impact on their life, but each continued to be active members in these groups. As these individuals described:

I think that anybody involved in any kind of outreach, I think, to have that access is fantastic, it is almost a priority, because if you’re in a situation where your family or your friends don’t or understand or don’t want to understand the situation that you found yourself in having that as a as a backup as a support I found it. (Male, Bombing, England)

Yeah hundred percent if it wasn’t for that group, it would have been awful. I got all my information from that group so where to go, like where to get the Seventh of July assistance from, compensation where to go for that, when the memorial services were. . . that was so critical and that is one thing that I would say to any they need to have somewhere where people can go and talk. (Female, Bombing, England)

Furthermore, almost half the sample stated that they increased usage in alcohol or drugs after the terrorist attack, with five participants stating that the increase in substance use was high for a period following the attack but decreased to pre-attack levels over time. Of note, none of the individuals with physical injuries reported an increase in substance use following the attack. Only those experiencing mental health injuries expressed an increase in substance use. As one participant stated:

So I was drinking a lot, I was smoking some pot and stuff and about two weeks later, my wife doesn’t remember this, and she said to me one night, it was like two o’clock I was, I couldn’t be in the house, I had a lot of problems being in the house, so I was in my garage with [friend] until 11-12 o’clock in the night, and you know what she said to me two weeks later, she goes, ‘So is this how it’s going to be?’ And I said, I stopped that day, I said we’re done, I said I can’t I can’t do this yeah. (Male, Hijacking, USA)

Discussion

Overall, the findings indicate that direct victims of terrorist attacks can be impacted in large ways in multiple areas of their lives, completely altering the course of their lives in some cases. There is a high degree of variance between victims of terrorist attacks and their experiences. How their life will be after the attack can be impacted by the kind of support they receive, whether they experience feelings of validation or isolation, and the injuries they sustain (mental, physical, or both). While each area an individual can be impacted is unique, be it activities, behavior, or mental health, each interacts with and shapes each other, and there are many commonalities among experiences from individuals of very different backgrounds and victimization experiences.

For many survivors of terrorist attacks, individuals often form new bonds and connections with people with shared experiences, and they can gain validation and reduce feelings of isolation or feeling forgotten from peers and support groups. These individuals commonly form new groups with other victims, leading to social changes and greater associations with similar peers (Nijenhuis and den Boer, 2010). Many individuals find a new or greater purpose in their lives, exhibited in changing careers or becoming active as a victim advocate or in related non-profit organizations. In this regard, some victims exhibit characteristics of PTG (Taku et al., 2021). In the present study, those with PTG characteristics were more often those who stated a greater propensity to help others following the victimization and those with physical injuries. There was also a high overlap with prior negative experiences or negative childhood experiences and a willingness or need to help others following their attack, which could be related to increased empathy for those who have been through something similar because they did not have anyone to do that for them.

Throughout the interview process (and as the findings reflect), it became apparent that there was a clear distinction between victims who were physically injured and those who did not have a physical injury, but who had mental health injuries, not only among the victims themselves but with policy as well (Wiseman et al., 2013). Assessing who is a survivor and who should receive victim compensation is more straightforward for those who have been physically injured as there is something visible to assess. This leaves those without physical injuries in a precarious place as they still may have been greatly impacted or injured mentally but now must navigate any of these issues while simultaneously dealing with the difficult task of proving they are having these issues and receiving some support for it. The complicated nature of receiving formal validation and thus adequate resources for mental health issues is often pushed to the side in favor of providing resources for physically impacted people and families, adding to feelings of being forgotten, isolation, and loneliness.

A lack of validation of feelings and experiences can have far-reaching ramifications on an individual when psychosomatic issues start impacting a person’s behavior. Victims with mental health injuries are more likely to experience isolation and loneliness along with higher levels of substance use. And while the participants in this study indicated the unfairness of the division between those with physical injuries and those without, it is worth noting that the findings indicate that there may be substantial differences between the two groups, the overall impact of the attack on various areas of life, and how policy can provide the greatest benefits for both groups of victims focusing on the uniqueness of each. For those who have been physically injured, they now face a new physical limitation to overcome and potentially must navigate for the rest of their life (Wiseman et al., 2013). For these individuals, their priorities shift to address these new bodily complications, and many must make life-altering adjustments to accommodate the changes, acting as a catalyst for growth while, at the same time, receiving formal and informal validation and resources from people and governments about their experiences.

For those without physical injury, there is often a lack of recognition or validation, on top of a psychosomatic illness, which will lead the victim to further isolate, lose trust, and harbor feelings of insecurity, increasing the likelihood that they will engage in behaviors to increase safety and security and reduce the negative feelings. Curiously, it seems that being able to help other people in similar victim situations or otherwise provides fulfillment, purpose, and positivity to these individuals, possibly reflecting their desire to reclaim some control or sense of power in their life. These victims are a unique and often overlooked group of people, especially relating to policy, memorials, anniversaries, public recognition, compensation, and many other resources, but though these do not often happen through formal channels, informal support groups, and ‘grassroots’ initiatives by survivors for survivors are quick to form and provide a place for everyone who was impacted, increasing solidarity and providing a peer support network to rely on.

Recommendations by victims for victims

Many participants in the study demonstrated immense growth and implored other aggrieved survivors to talk openly and unapologetically about their experiences. All these victims have experienced something that has become a building block in each of their daily lives. They urge governments to provide victims with an outlet to help them cope with stress and discuss their trauma and to not isolate victims after an attack. As one participant stated:

Don’t allow the authorities to isolate you . . . Don’t allow to be isolated and try to connect with other survivors straight away, and if you are a bit more outspoken and brave request to be connected with support groups from survivors. (Female, Armed Assault, Denmark)

Participants further expressed the importance of discussing their lived experiences because these past events can govern their reactions to everything and everyone they encounter. Sharing their experiences helped many to reduce their feelings of isolation and instill a sense of validation within themselves. Furthermore, participants claimed that when they were able to talk about their experiences to help others, they felt exalted and newly alive. These survivors offer a unique perspective from their experiences. When these victims are prioritized, they feel a sincere, heartfelt appreciation and are able to make contributions to better help other victim’s lives, which in turn provides positive aspects in their own. As these individuals described:

Get help, get the right help, there is no one shoe fits all but get help, talk to someone, preferably talk to someone who’s experienced this because they are the ones who will understand . . . With time your perspective is going to change. It’s not going to go away, but with help your experience will find a place to live. But you need you need to allow this experience to find somewhere to live in you, because it will now be a part of your collective. Not who you are but of your of what has happened to you in your life. (Female, Armed Assault, Denmark)

I definitely think that it’s important to get connected with other survivors . . . I guess, we all who have gone through it have this some level of PTSD, but I would say that for me, really, focusing on, not maybe in spite of it, but because of it, because I think that I learned some things that I might not have learned otherwise and so I think that those difficult times in your life, if you allow them to can grow, grow your character and so getting connected with people that not only have those same sort of experiences and can walk that pathway, but also people that are willing to not let you sit in it and stew in it, but can help you to navigate through sort of this growth process. (Female, Suicide Bombing, Uganda)

After a terrorist attack, governments are ordinarily forthcoming with financial assistance to victims, although victims feel disparities when there is physical versus mental injuries. Yet, as time passes, assistance subsides, and victims are often left feeling isolated and without adequate support. Loneliness can exacerbate mental health issues and lead to higher levels of substance use. There is a societal expectation that a victim’s pain should be diminished with time. While victims can heal, and may demonstrate areas of growth, the fact remains that their experiences stay with them for life. Numerous survivors advocated that governments should provide long-term resources for those impacted. There are many instances where victims of terrorism resume their daily lives only to realize later that they been affected by their traumatic encounters. Support should be available to these survivors whether the victim comes forward 2 days after the incident or 2 years down the line. The lack of support can hinder growth and limit a victim’s restorative process. Victims should be provided with emotional support groups, counseling services, and resources to better navigate their road to recovery. When governments take the step to acknowledge and recognize survivors, it inculcates them with a sense that they are not fighting alone. The voices of victims are very powerful, but to be amplified, they need encouragement and support from the government.

While the present study aimed to examine the impact of terrorist attacks on direct victims, there were several limitations. Each participant was a member of a terrorist attack victims’ group, so victims who are not in support groups were not included, which could be a population with unique characteristics after an attack. The study only focused on direct victims, which does not include all individuals who are impacted in various ways by attacks. The study also relied on snowball sampling from one victims’ group, resulting in a limited number of participants and experiences. Future research could expand on these by further examining policies in response to attacks, victim compensation, and including victims who are not involved in support groups.

Footnotes

ORCID iD

Jordan Bos

References

Bard

Sangrey

(1986) The Crime Victim’s Book. New York: Brunner/Mazel.

Bjørgo

Jupskås

(2021) The long-term impacts of attacks: The case of the July 22, 2011 attacks in Norway. Perspectives on Terrorism 15(3): 2–13.

Bolton

Hill

O’Ryan

, et al. (2004) Long-term effects of psychological trauma on psychosocial functioning. The Journal of Child Psychology and Psychiatry 45(5): 1007–1014.

Bugge

Dyb

Stensland

SØ

, et al. (2017) Physical injury and somatic complaints: The mediating role of posttraumatic stress symptoms in young survivors of a terror attack. Journal of Traumatic Stress 30(3): 229–236.

Burgess

Holmstrom

(1979) Rape: Sexual disruption and recovery. American Journal of Orthopsychiatry 49(4): 648–657.

Collier

(2016) Growth after Trauma: Why are some people more resilient than others- and can it be taught? Monitor on Psychology 47(10): 48.

Desivilya

Gal

Ayalon

(1996) Extent of victimization, traumatic stress symptoms, and adjustment of terrorist assault survivors: A long-term follow-up. Journal of Traumatic Stress 9(4): 881–889.

Eliashar

Zilberstein

Shmulewitz

, et al. (2024) Reported increase in substance use following mass terrorism and the role of psychosocial factors. JAMA Network 7(7): e2423993.

Farfel

DiGrande

Brackbill

, et al. (2008) An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center health registry enrollees. Journal of Urban Health 85: 880–909.

10.

Farooqi

Habib

(2010) Gender differences in anxiety, depression and stress among survivors of suicide bombing. Pakistan Journal of Social and Clinical Psychology 8(2): 145–153.

11.

Foner

(ed.) (2005)  Wounded City: The Social Impact of 9/11 on New York City. New York: Russell Sage Foundation.

12.

Friedman

Bischor

Davis

, et al. (1982) Victims and Helpers: Reactions to Crime. New York: Victim Services Agency.

13.

Galea

Resnick

(2002) Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine 346(13): 982–987.

14.

Glad

Aakvaag

Wentzel -Larsen

, et al. (2024) What will others think of me? The longitudinal association between trauma-related shame and guilt and psychopathology after a terror attack. BJPsych 10(1): e30.

15.

Global Terrorism Database (GTD) (2025) START.umd.edu. Available at: https://www.start.umd.edu/data-tools/global-terrorism-database-gtd (accessed 11 May 2025).

16.

Grieger

Fullerton

Ursano

(2003) Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the Pentagon. Psychiatric Services 54(10): 1380–1382.

17.

Hindelang

Gottfredson

IVR

Garofalo

(1978) Victims of Personal Crime: An Empirical Foundation for a Theory of Personal Victimization. Cambridge, MA: Ballinger.

18.

Huddy

Feldman

Capelos

, et al. (2002) The consequences of terrorism: Disentangling the effects of personal and national threat. Political Psychology 23(3): 485–509.

19.

Hussain

Iqbal

Taj

, et al. (2012) Impact of terrorism on mental health. Annals of Pakistan Institute of Medical Sciences 8(1): 46–49.

20.

Lasky

Bonnie

Fisher

, et al. (2017) Binge drinking, Greek-life membership, and first-year undergraduates: The ‘perfect storm’ for drugging victimization. Journal of School Violence 16(2): 173–188.

21.

Luhmann

Bleidorn

(2018) Changes in affect, cognition, and perceived behavioral changes among vicarious victims of the Paris terrorist attacks of November 13, 2015. Social Psychological and Personality Science 92(2): 214–222.

22.

McAdams

McLean

(2013) Narrative identity. Current Directions in Psychological Science 22(3): 233–238.

23.

Miguel- Tobal

Cano Vindel

Iruarrízaga

, et al. (2005) Psychopathological repercussions of the March 11 terrorist attacks in Madrid. Psychology in Spain 9(1): 75–80.

24.

Mueller

(2007, February). Reacting to Terrorism: Probabilities, Consequences, and the Persistence of Fear [Prepared for the National Convention of the International Studies Association]. Albany, NY: State University of New York Press.

25.

Murphy

Poynting

(2010) Terrorism, the State and the Study of Political Terror [Contemporary State Terrorism: Theory and Practice]. London: Routledge.

26.

Nacos

(2019) Terrorism and Counterterrorism. 6th ed. London: Routledge.

27.

Nader

(2001) Guilt following traumatic events. Gift from within—PTSD resources for survivors and caregivers, Available at: https://www.giftfromwithin.org/ (accessed 13 June 2024).

28.

Nijenhuis

van der Hart

Steele

(2010) Trauma- Related Structural Dissociation of the Personality. Activitasnervosa Superior 52(1): 1–23.

29.

Nijenhuis

den Boer

(2010) 21 psychobiology of traumatization. Dissociation and the Dissociative Disorders: DSM-V and beyond: 337–365.

30.

Norris

Stevens

(2007) Community resilience and the principles of mass trauma intervention. Psychiatry: Interpersonal and Biological Processes 70(4): 320–328.

31.

Norris

Diaz

Perilla

, et al. (2005) Violence and PTSD in Mexico: Gender and regional differences. Social Psychiatry and Psychiatric Epidemiology 40: 519–528.

32.

Parkin

(2015) Examining the effect of repressive and conciliatory government actions on terrorism activity in Israel. Economics Letters 133: 55–58.

33.

Paz Garcia-Vera

Sanz

Gutierrez

(2016) A systematic review of the literature on posttraumatic stress disorder in victims of terrorist attacks. Psychological Reports 119(1): 328–359.

34.

Peek

(2003) Reactions and response: Muslim students’ experiences on New York City campuses post 9/11. Journal of Muslim Minority Affairs 23(2): 271–283.

35.

Pratt

Turanovic

(2016) Lifestyle and routine activity theories revisited: The importance of ‘risk’ to the study of victimization. Victims and Offenders 11(3): 335–354.

36.

Rader

May

Goodrum

(2007) An empirical assessment of the ‘threat of victimization’: Considering fear of crime, perceived risk, avoidance, and defensive behaviors. Sociological Spectrum 27: 475–505.

37.

Rathore

(2011) Gender Equality as a Counter-Terrorism Measure: The Case of Female Maoists. New Delhi, India: Social and Political Research Foundation.

38.

Sabir

Aslam

(2011) Impact of suicide bombing on the cognitions of victims. Journal of Behavioural Sciences 21(1): 109–125.

39.

Shamai

Ron

(2009) Helping direct and indirect victims of national terror: Experiences of Israeli social workers. Qualitative Health Research 19(1): 42–54.

40.

Silver

Wortman

(1980) Coping with undesirable life events. In: Garber

Seligman

MEP

(eds) Human Helplessness: Theory and Applications. New York: Academic Press, pp.279–375.

41.

Spilerman

Stecklov

(2009) Societal responses to terrorist attacks. Annual Review of Sociology 35: 167–189.

42.

Steele

(2018) Survivors of violence and trauma. Psychiatric Nursing-Ebook 417–436.

43.

Taku

Tedeschi

Shakespeare-Finch

, et al. (2021) Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) across ten countries: Global validation of the PTG-PTD theoretical model. Personality and Individual Differences 169: 110222.

44.

Tedeschi

Calhoun

(1996) The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress 9(3): 455–471.

45.

Tedeschi

Calhoun

(2004) Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry 15(1): 1–18.

46.

Ten Boom

Kuijpers

(2012) Victims’ needs as basic human needs. International Review of Victimology 18(2): 155–179.

47.

Tin

Galehan

Markovic

, et al. (2021) Suicide bombing terrorism. Prehospital and Disaster Medicine 36: 664–668.

48.

United States. Office of Justice Programs. Office for Victims of Crime (2000) Responding to Terrorism Victims: Oklahoma City and beyond. Washington, DC: US Department of Justice, Office of Justice Programs, Office for Victims of Crime.

49.

Vergani

Daryanomel (2018) How Is Terrorism Changing Us? Basingstoke: Palgrave Macmillan.

50.

Wiseman

Foster

Curtis

(2013) Mental health following traumatic physical injury: An integrative literature review. Injury 44(11): 1383–1390.