Extensive exposure to Boston Marathon bombing media coverage caused more acute stress in people watching on TV, online or listening to radio reports than in those experiencing the terrorist attack itself, researchers at UC Irvine have found. Even the study authors who specialize in researching trauma impacts said they were startled by their findings: People engaged in six or more hours of bombing accounts -- even without visuals \u2013- were nine times more likely to report symptoms of post-traumatic stress disorder (PTSD) than the bombing victims. The study involved online interviews with 4,675 people in the first week or two after the April 2013 explosions at the Boston Marathon finish line. Four people were killed and more than 260 people hurt when the crudely made bombs went off. Many of the survivors, including children, lost limbs and some suffered brain damage, for which at least $30 million was raised to help pay medical expenses, Boston.com reported. Study at Odds with DSM 5 The study challenges key assumptions about how people react to collective traumas, such as the idea that individuals must be directly exposed to an event to be at risk for stress-related disorders, UCI researchers reported. It also raises questions about the latest edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), which specifically excludes media-based exposure as a potential trigger for trauma response. \u201cWe suspect that there\u2019s something about repeated exposure to violent images or sounds that keeps traumatic events alive, and can prolong the stress response in vulnerable people,\u201d wrote the study\u2019s lead author, E. Alison Holman, associate professor of nursing science at UC Irvine. \u201cThere is mounting evidence that live and video images of traumatic events can trigger flashbacks and encourage fear-conditioning. If repeatedly viewing traumatic images reactivates fear or threat responses in the brain and promotes rumination, there could be serious health consequences.\u201d The study, supported by the National Science Foundation, was published in an online edition of Proceedings of the National Academy of Sciences, and survey subjects were re-interviewed in October 2013, at six months post-bombings. The impacts of trauma have been the focus of research for the team over several years. \u201cIn our prior work,\u201d said Roxane Cohen Silver, UCI professor of psychology and social behavior, medicine and public health, \u201cwe found that early and repeated exposure to violent images from the terrorist attacks of Sept. 11 and the Iraq War may have led to an increase in physical and psychological ailments up to three years . Our new findings contribute to the growing body of research suggesting that there is no psychological benefit to repeated exposure to graphic images of horror.\u201d Chechen brothers Dzhokhar and Tamerlan Tsarnaev made the shrapnel bombs and hid them near the finish line of the historic street marathon and the older brother, Tamerlan, the alleged mastermind of the attack, was killed a few days later in a shoot-out with police that left one officer dead. The wounded younger brother will stand trial for his role in the attack. While it devastated an iconic American race, researchers said they suspect survivors fared so much better than second-hand victims of media coverage exposure for a couple of reasons. One is that the timing of bombs was right near shift change at area hospitals, so double the number of staff were on site to treat victims. They also said Boston\u2019s first responders were magnificent at handling victims and that the city shined with resilience. Though traumatic, the bombings have prompted a staggering $61 million in donations for victims, and goodwill that included an all-expenses paid cruise in December to the south of France for 114 bombing victims, relatives and first responders. Onboard was a survivor with significant burns treated with pig skin grafts. He emailed the Boston Globe to share that he was traveling with one of his nurses, and they\u2019d gotten engaged during the trip. But why survivors of the blasts gritted through the experience with less severe stress symptoms than followers of the news coverage will be addressed in further study, Holman told Promises Behavioral Health. Severe stress may prompt the fear response -- a physiological reaction, also known as the fight-or-flight response. The symptoms may include intrusive thoughts about the violence, rumination and flashbacks of the event. Temper Exposure to Traumatic Events \u201cThe take away is two-fold,\u201d Holman said. \u201cWe recommend people temper their exposure major community-based trauma events. Find out what you need to find out, but don\u2019t oversaturate, don\u2019t overdo it. Certainly don\u2019t keep looking at pictures\u2026. People need to learn to monitor that themselves. The second is that media outlets need to understand that there may be impacts to the repetitive showing of gruesome impacts. We just don\u2019t know what the impact is on the brain, how people process internally. What we do know is the more they watch, the more they see and hear, the more acute stress symptoms they have. We want to encourage caution in viewers and thoughtful display of images in the media.\u201d Others noted that while preliminary, the study's findings hint at important impacts of media exposure. \u201cDue to its potentially profound personal and public health implications, conducting research of the impact of media coverage of communal traumatic events is very important,\u201d said Dr. Christine A. Courtois, a national trauma consultant on staff with Promises Behavioral Health, who authored \u201cTreatment of Complex Trauma\u201d in 2013. \u201cI have anecdotally heard of findings like those reported here but also just the opposite,\u201d Courtois added. \u201cJust three weeks ago, I heard a prominent PTSD expert at an international trauma conference \u2018pooh-pooh\u2019 the idea that media exposure could lead to actual symptoms of ASD or PTSD. Thus, it is good to begin to gather \u2026 findings that media coverage can diffuse acute stress disorder across the population and can be more impactful than direct exposure are highly significant.\u201d According to the U.S. Department of Veteran Affairs, the four types of PTSD symptoms are: 1. Reliving the event (also called re-experiencing symptoms) Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example: You may have nightmares. You may feel like you are going through the event again. This is called a flashback. You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers. 2. Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example: You may avoid crowds, because they feel dangerous. You may avoid driving if you were in a car accident or if your military convoy was bombed. If you were in an earthquake, you may avoid watching movies about earthquakes. You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event. 3. Negative changes in beliefs and feelings The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following: You may not have positive or loving feelings toward other people and may stay away from relationships. You may forget about parts of the traumatic event or not be able to talk about them. You may think the world is completely dangerous, and no one can be trusted. 4. Feeling keyed up (also called hyperarousal) You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal. For example: You may have a hard time sleeping. You may have trouble concentrating. You may be startled by a loud noise or surprise. You might want to have your back to a wall in a restaurant or waiting room.