PTSD
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PTSD is the acronym for post-traumatic stress disorder.
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Overview of PTSD
Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that is brought on by exposure to extreme physical harm or danger. Near-death experiences, torture or extreme bodily harm, disaster, physical or sexual assault, or psychological damage and affliction can all lead to PTSD. People who directly lived through or were witnesses to such events can develop the disorder.
PTSD is most commonly associated with war combat, although similar diagnoses have emerged from industrial/occupational accidents and events of such traumatic psychological/physical intensity as that of survivors of Nazi concentration camps. Prior to its modern taxonomy, PTSD has also been classified as “railroad spine syndrome,” “exhausted heart,” “irritable heart syndrome,” “neurocirculatory asthenia,” “shell shock,” “war neuroses,” “physioneurosis,” “gross stress reaction,” or “battle fatigue.”
Symptoms include reliving the trauma through flashbacks or nightmares, disturbing thoughts, somatization (complaints of physical symptoms that have no identifiable physical origin), increased startle, increased arousal, exaggerated stress responses when reminded of the severe trauma, avoidance of the triggering stimulus or associations of it, despondency, depression, memory loss, insomnia, and anger outbursts. If these symptoms occur for only a few weeks, the condition is known as acute stress disorder (ASD), which is a similar disorder but isn’t as chronic as PTSD, since PTSD remains with the afflicted individual for long (even ongoing) periods of time due to constant emotional stress.
The disorder can affect a person at any age, although young children and teenagers express variations of these symptoms. The normal bodily instinct to “fight or flight” when experiencing fear is permanently damaged or injured, and affected persons can become afraid without a stimulus due to the perception that the threat is still present. Although the existence of PTSD has been reported since ancient times and has been significantly researched since the 18th century, the modern recognition of the disorder did not become concrete until the 1980 publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) when its symptoms were officially distinguished from those of other anxiety disorders.
For those with PTSD, everyday activities can become difficult or impossible to perform, even activities that the individual once enjoyed. Sleeping, eating, and concentration are affected, and school, work, and relationships become seriously impaired. A psychiatrist or psychologist can diagnose the disorder, and treatment is usually customized to each individual situation and involves a combination of psychotherapy and prescribed medication. It may take several attempts before an effective treatment is found suitable to each individual’s needs, yet anyone experiencing PTSD should always seek medical treatment. If PTSD is left untreated, suicidal thoughts, substance abuse, panic disorder, or forms of depression may evolve.
History of Attitudes Toward PTSD
The term Posttraumatic Stress Disorder or PTSD was first formally used by the American Psychiatric Association as a medical diagnosis in 1980. At that time, the 3rd edition of their Diagnostic and Statistical Manual listed Posttraumatic Stress Disorder as a distinct disorder. It was understood to be a reaction to extraordinarily stressful events such as war, natural disasters, man-made disasters, torture and the Holocaust. Such events were considered “traumatic “as opposed to other stressors in more ordinary life such as loss, illness and financial ruin.
Medical Diagnosis vs. Character Weakness
The designation of PTSD as a medical diagnosis was a significant milestone in defining the cause of severe stress reactions. Prior to the use of this diagnosis it was thought that individuals who experience such reactions were somehow flawed or weak in character. PTSD as a diagnosis helped define the extreme traumatic event itself as understandably debilitating to anyone exposed to it. The catastrophic nature of some historical events helped further the understanding that intense distress could understandably impair an individual's ability to cope. This significantly changed the prevailing and historical perspective which had considered individuals strong in mind and character to be able to psychologically withstand extreme distress without impaired coping.
“Good” Soldiers
The combat-related difficulties of soldiers at war have been noted throughout history. Until PTSD was more thoroughly understood in modern psychiatry, distressed soldiers themselves were seen as individuals not suitable for military service. Considered weak in character or in psychological makeup, soldiers who became debilitated in combat were deemed inadequate. Hand-to-hand combat, prolonged and severe deprivation of adequate clothing, shelter, food, rest and medical attention were viewed as conditions in which an adequate soldier could perform well without suffering dire psychological effects. Soldiers have also been steadily exposed to advances in weaponry which have significantly increased the likelihood of serious personal injury and death as well as the need to routinely witness the injury and death of others. Until the 1980s, when the traumatic event itself (war) was understood to be the cause of combat-related difficulties, good soldiers were expected to cope well in such extreme and catastrophic survival conditions.
“Bad” Soldiers
While PTSD is a relatively new concept in understanding the effects of wartime and other extreme stressors, its symptoms are as old as the human condition. Our knowledge of combat-related PTSD is centuries old, written by people who observed soldiers in combat and after. As early as the 17th century, Swiss and German military physicians began to identify common symptoms of melancholy, anxiety, fatigue and stupor among soldiers on the battlefield. It was thought at the time that these symptoms were a type of homesickness. Other combat-related PTSD symptoms were identified in later years by French and Spanish physicians such as suicidality, confusion and disorientation. Soldiers with these symptoms were described as “broken”, weak and inferior. The implications were that soldiers disabled by combat stress were somehow at fault. During the American Civil War in the 1800s, military doctors identified a condition called soldier's heart. Soldiers on the battlefield were observed to be fearful, have tremors, paralysis, heart palpitations and other symptoms now known to be reactions to severe and debilitating combat-related stress. Large numbers of affected soldiers during that war caused the US military to establish its first military hospital, however, soldiers displaying such symptoms and behaviors were commonly considered to be cowards and inadequate soldiers.
Traumatized Soldiers
Combat-related PTSD symptoms were recognized in World War I and World War II, but not fully considered to be a medical diagnosis. Then, distressed soldiers were often described as having combat fatigue, battle fatigue or shell shock. The number of stress affected soldiers in the Vietnam War, however, was so great that military and civilian medical communities acknowledged a freestanding emotional disturbance caused by the conditions of that war. Physicians began to diagnose soldiers with a combat-related stress condition known as the Post-Vietnam-Syndrome. The diagnosis of Post-Vietnam Syndrome became the precursor to PTSD as it is known today.
Beyond War
Research into the nature of trauma grew steadily in the 1980s and 1990s. This resulted in a more comprehensive understanding of the types of traumatic events that can cause PTSD. For example, victimization through sexual and physical abuse is now commonly accepted as powerfully adverse experiences that can trigger PTSD. It is not, however, the specifics of an event but rather an individual's experience of it that determines whether or not clinically significant trauma occurs. The early focus upon extraordinary human events such as war and disasters has now receded to include any event that causes overwhelming distress and persisting symptoms of distress. An event likely to be traumatic is typically considered to be any situation in which a person experiences the following:
• the threat of death
• actual or possible injury or loss of physical integrity
• the death of others
• the endangerment of others
Such events can be experienced firsthand, witnessed or learned about after they have happened. While events such as those described above must be experienced in order for an individual to be diagnosed with PTSD, the occurrence of such events is not in itself enough to warrant diagnosis. Exposure to such an event must cause intense fear, helplessness or horror In order to be considered clinically traumatic. Additionally, one must have persisting symptoms of trauma after the event in order to be diagnosed with PTSD.
There is a wide range of events now commonly considered to be possible causes of PTSD if an individual’s response is psychologically overwhelming. While this is not an exhaustive list, some of these include:
• war
• rape
• torture
• displacement
• kidnapping
• sexual abuse
• physical abuse
• domestic violence
• car accidents
• illness
• injury
• significant loss
• financial ruin
• addiction
• surgery
• violence
• seeking refuge or asylum
• incarceration
• hospitalization
• hurricanes, tornadoes, earthquakes, floods
• industrial accidents, explosions, fires, airplane crashes, train wrecks, infrastructure collapse/disasters
• severe deprivation such as starvation or exposure
• living with others who have PTSD, mental illness, addiction or some other impairment
• caring for others in severe distress
See also: trauma echo | trauma reaction
