Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) was adopted by the American Psychiatric Association (APA) as part of the official classification of psychiatric disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III), published in 1980. The adoption of PTSD in DSM-III was motivated by pressures from advocates on behalf of Vietnam War veterans. The definition of PTSD in the DSM-III and subsequent DSM editions, DSM-III-R and DSM-IV, is based on the concept that traumatic events, in contrast with other stressful events, are linked etiologically to a specific syndrome. The PTSD syndrome is defined by three symptom groups: (1) reexperiencing the traumatic event, (2) avoidance of stimuli that resemble the event and numbing of emotional responsiveness, and (3) increased arousal. These features are defined in terms of their connection with the traumatic event that caused them. Temporal ordering is also required: These disturbances must not have been present before the trauma occurred.

Since 1980, research on PTSD has focused chiefly on Vietnam War veterans and to a lesser degree on victims of specific types of traumas, such as natural disasters or rape. With the growth of the field of psychiatric epidemiology, PTSD has been studied in samples of the general population in the United States and other countries. From the time of its introduction into the official psychiatric nosology, PTSD has been a controversial diagnosis. Some critics question its validity as a distinct disorder. Others contest the trend toward a broader, more inclusive definition of what constitutes a traumatic event. Concerns have been expressed about the proliferation of PTSD-related disturbances other than DSM-IV PTSD (e.g., subthreshold PTSD) and about potential distortion in recalling traumatic experiences, especially when the diagnosis of PTSD entitles victims to compensation. Despite extensive efforts, neurobiological research has not yielded laboratory tests that can be used diagnostically.