Researchers in London have documented the case of a ten-year-old boy with Tourette's syndrome and obsessive compulsive symptoms, who believed the terror attacks of 9/11 occurred because he had failed to complete one of his daily rituals.
Mary Robertson and Andrea Cavanna claim this is the first ever case reported in the literature of a person believing they were responsible for causing a major disaster of the proportion experienced in America in 2001.
The boy - described as "extremely pleasant and likeable" and with good school grades - was first referred for consultation a year before 9/11 took place. As is characteristic of people with Tourette's syndrome, the boy displayed several forms of uncontrollable tics, including excessive blinking and vocal outbursts, and he also showed obsessive tendencies and attentional problems.
Robertson next saw the boy two weeks after 9/11, at which point he was in a terrible state - "tortured", as he put it, by his tics, and wracked with guilt, believing that 9/11 occurred because he had failed to walk on a particular white mark on a road.
This was just one of the many rituals the boy had developed during the course of the year. Others included so-called "dangerous touching" rituals, including the need to feel the blade of knives to check their sharpness, and to put his hand in the steam of a kettle to check its heat.
Importantly, the researchers said the boy's beliefs about 9/11 were distinct from the kind of delusions expressed by people with psychosis, and instead reflected an extreme form of the anxiety that people with obsessive compulsive disorder often experience when they fail to complete their rituals.
Fortunately, a mixture of drug treatments and reassurance (including explaining to the boy that his missed ritual actually occurred after 9/11, given the time difference between the USA and UK), led to him realising that he was not responsible for the attacks.
Robertson and Cavanna said this case study brings attention to the way our modern media - "immediate, realistic, and evocative" - can lead to terrorist attacks and other disasters having harmful effects on vulnerable people miles away from the immediate environment of what happened. "Only time will reveal the many further psychosocial sequelae of 9/11, as well as the Madrid and London terrorist bombings," they said.
Robertson, M., Cavanna, A. (2008). The Disaster was my Fault!. Neurocase DOI: 10.1080/13554790802001395
Update: Following our coverage of this case study, BBC Radio Four's All in the Mind followed up the story and spoke to Dr Andrea Cavanna in July 2008 about the boy.