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Definition and history of PTSD

Definition and history of PTSD
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The interest in psychological trauma and its effects on health and wellbeing dates back hundreds, if not thousands of years. Post-traumatic stress disorder is a relatively new diagnostic term broadly used to denote disordered psychosocial adjustment following a traumatic event. Both the Iliad and the Aeneid make mention of aspects we might now associate with PTSD. In Herodotus’ account of the Battle of Marathon, written and 440 BC, there’s an account of a soldier experiencing chronic mental health symptoms following exposure to combat. Thousands of years later, in 1388, Jean Froissar also described symptoms, including nightmares and flashbacks in a Knight who had fought in the Hundred Years War.
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In the 19th century, following further observations of psychological problems among those involved in conflicts such as the French Revolutionary War, the Napoleonic wars, and the American Civil War, a more scientific approach to studying reactions to trauma was adopted. Jean-Martin Charcot wrote about traumatic hysteria, proposing the hidden mental processes lead to physical symptoms following exposure to trauma. Pierre Janet, a student of Charcot, developed this work, focusing on the mental effects of trauma exposure, such as feelings of dissociation and maladaptive behaviours. Early in the 20th century, the German neurologist Hermann Oppenheim proposed that exposure to trauma could have a detrimental effect on an individual’s nervous system. But his argument was roundly rejected.
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Following the Second World War, many different mental health issues were observed in soldiers, leading to further research. Grinker and Spiegel studied American Word War II aviators who developed mental disorders. And they emphasised that the symptoms they observed were the results of a field adaptation to stress. The first reference to stress in psychotraumatology came in 1952 when a post-traumatic condition called gross stress reaction was detailed in the American Psychiatric Association’s diagnostic and Statistical Manual, DSM-I. The condition was, again, included in DSM-II in 1968. In both instances, it was classed as a transient disorder, meaning those affected by the condition were not eligible for disability payments.
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This is symbolic of the prejudice that existed against those who had developed mental disorders after exposure to trauma. The term post-traumatic stress disorder was first used in DSM-III, published in 1980. The eventual inclusion of PTSD and DSM-III was a result of activism by Vietnam War and other veterans, as well as their supporters who wanted the adverse psychiatric consequences of exposure to combat to be recognised as a health condition so that they could be treated and receive service-related disability. The DSM-III also represented the first time that reactions to different kinds of trauma were unified under a single diagnosis. Previously, conditions had been described, depending on which event had preceded the development of symptoms– for example, post-Vietnam syndrome.

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This animation presents a short history of PTSD as a distinct clinical entity.
There are various definitions of PTSD available. For the purposes of this course, the definition presented in the International Statistical Classification of Disease and Related Health Problems Version 11 (ICD-11) is accepted and used. Take some time to read about the definition of PTSD according to ICD-11.
The International Statistical Classification of Disease and Related Health Problems Version 11 (ICD-11) was published in 2019 and conceptualises PTSD as a disorder that:
“may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following:
  • Re-experiencing the traumatic event or events in the present in the form of vivid, intrusive memories, flashbacks or nightmares. These are typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations.
  • Avoidance of thoughts and memories of the event or events, or avoidance of activities situations, or people reminiscent of the event or events; and Persistent perceptions of heightened current threat for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises.
  • The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning” (WHO ICD-11).
This definition aims to reduce the overlap with other diagnoses while still being clinically useful.
References
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47-55. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/
Pitman, R. K. (2013). A Brief Nosological History of PTSD. Journal of Traumatic Stress Disorders & Treatment, 2(1). https://doi.org/10.4172/2324-8947.1000101
World Health Organisation. (2019). International Statistical Classification of Diseases and Related Health Problems (11th Revision). https://icd.who.int/en/
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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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