One thing Dennis had
brought up for this discussion many times is to be aware that not
all physiological manifestations indicate exposure or are symptoms
or indicators of a biological attack. Many stress-induced physical
symptoms that mimic the effects of exposure are seen in first
responders and the public as a whole.
Of particular importance is
a phenomenon studied called “multiple unexplained physical
symptoms” (MUPS) that has been noted after disasters, criminal
assault, and warfare. In addition to MUPS, there may also be
emergent and maladaptive reactions involving groups of people
(i.e., collective psychosocial reactions) in the aftermath of
terrorism and large-scale public health emergency events, such as
mass sociogenic illness (sometimes also called mass psychogenic
