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Recognizing post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a severe and complex disorder precipitated by exposure to a psychologically distressing event. PTSD first appeared in the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-III) in 1980,1,,2 arising from studies of the Vietnam war, and of civilian victims of natural and man-made disasters.3,,4 However, the study of PTSD dates back more than 100 years. Before 1980, post-traumatic syndromes were recognized by different names, including railway spine, shell shock, traumatic (war) neurosis, concentration-camp syndrome, and rape-trauma syndrome.2,,3 The symptoms described in these syndromes overlap considerably with what we now recognize as PTSD. According to the most recent edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV-TR),5 the essential feature of PTSD is the development of characteristic symptoms following exposure to an extreme traumatic stressor characterized by: 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. The person reacts to this event with fear and helplessness, and tries to avoid being reminded of it. Traumatic events include military combat, violent personal assault, being kidnapped, being taken hostage, terrorist attack, torture, incarceration, natural or man-made disasters, automobile accidents, or being diagnosed with a life-threatening illness. The principal symptoms of PTSD are the painful re-experiencing of the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal.

Post-traumatic reactions fall on a continuum, and many clinicians and researchers believe it is useful to conceptualize partial symptoms as well.2, …