Post-Traumatic Stress Disorder (PTSD) is a diagnosis that was first made following the Vietnam war. Veterans who saw combat in Vietnam were found to have a number of symptoms not clearly documented in any other diagnostic category. But in fact, these symptoms had been observed in combat veterans in many previous wars. It seems that PTSD is constantly being rediscovered.
War has always taken a toll. Accounts throughout history tell of nightmares and other emotional problems associated with the horrors of war. It seems that we repeatedly discover the effects of trauma on humans every time we go to war. Terms like "combat fatigue" and "shell shock" were used in the past to describe some of the effects of combat. These terms are misleading because they imply that the effects of combat are short-term. In the DSM-IV the term "Acute Stress Disorder" is used for a similar syndrome lasting less than 30 days.
We now know that PTSD can be caused by many other traumas. Child abuse survivors and survivors of plane crashes have many of the same symptoms as combat veterans. Psychotherapy and medications are both helpful for the symptoms of PTSD. The symptoms sometimes last for years, and there is not always a cure. Techniques such as EMDR may be helpful, especially for single-incident trauma. The sooner a person gets help, the better the outcome is likely to be.
The DSM-IV defines PTSD in the following manner:
Post-Traumatic Stress Disorder
1. The person has been exposed to a traumatic event in which both of the following were present:
- the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
- the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
2. The traumatic event is persistently re-experienced in one (or more) of the following ways:
- recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
- recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
- acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
- intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:efforts to avoid thoughts, feelings, or conversations associated with the trauma
- efforts to avoid activities, places, or people that arouse recollections of the trauma
- inability to recall an important aspect of the trauma
- markedly diminished interest or participation in significant activities
- feeling of detachment or estrangement from others
- restricted range of affect (e.g., unable to have loving feelings)
- sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- exaggerated startle response
5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.