Posttraumatic stress disorder PTSD

Psychiatry has always recognized that mental disorders can follow traumatic events. The names have tended to change over the years, including 'shell shock', 'war neurosis', or 'battle fatigue'. However, it was only in 1980 that DSM-III described PTSD; it appears in ICD also, and the diagnosis has evolved significantly since its introduction.

PTSD is described in survivors of major traumatic experiences of a kind outside the normal range of human experience. Such experiences include large-scale disasters, whether natural or man-made, which cause multiple deaths and injuries (for example, transport accidents and earthquakes); wartime combat; or individual trauma such as rape or domestic fire. The DSM sets out definitions of the various aspects necessary for a diagnosis of PTSD.

The traumatic event (DSM definition) must involve 'direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate' (criterion A1).

The person's immediate response (criterion A2) must have involved 'intense fear, helplessness, or horror'.

There are three cardinal groups of symptoms:

• re-experiencing the traumatic event (nightmares and flashbacks): criterion B

• avoidance of trauma-associated circumstances (cf. phobic anxiety): criterion C

• increased arousal (cf. generalized anxiety): criterion D.

There may be general feelings of detachment, loss of interest, inability to feel emotion, and 'survivor guilt'.

Finally, the symptoms must be present for more than 1 month (criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (criterion F).

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