Biological Effects of Physical and Psychological Trauma

History of Posttraumatic Stress Disorder

Among early writings acknowledging the symptoms of PTSD were those of Swiss military physicians in 1678 who described the reactions of soldiers to wartime experiences. The modern history of writings regarding PTSD dates to the U.S. Civil War period and is referenced under differing terminology yet always expresses the common and usual consequences of physical and psychological trauma. For example, during the Civil War, the emotional consequences of wartime trauma were described as “soldier's heart.” During World War I, the terms combat fatigue and shell shock were used to identify the emotional consequences of wartime trauma. However, the phenomenon of combat fatigue or shell shock was at times viewed as cowardice, and soldiers who could not return to combat activity because of PTSD were sometimes executed. During World War II, the term battle fatigue was used to refer to combatants with symptoms of PTSD. Writings expressing the effects of U.S. soldiers' wartime experiences continued to multiply during the Korean War, Vietnam War, and the more recent Iraq and Afghanistan wars.

Diagnosis of PTSD

The term posttraumatic stress disorder was first officially accepted in 1980 by the American Psychiatric Association as referenced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Currently, as referenced by the updated DSM-IV-TR, there are four necessary requirements for establishing a diagnosis of PTSD. Importantly, all four criteria must be met:

• 1.
  Exposure (directly experiencing trauma or witnessing trauma). By definition, the nature of the exposure involves actual or threatened death or serious injury, or a threat to one's physical integrity. The individual's response must result in intense fear, helplessness, or horror. In children, the response may involve disorganized or agitated behavior.
• 2.
  The consequences from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event. This typically includes flashbacks of the events (reexperiencing of the event during the daytime) and/or nightmares (dreams of the stressful event).
• 3.
  Avoidance of stimuli associated with the trauma by isolating oneself from activities that could lead to a recurrence of the trauma. For example, an individual who experienced or witnessed a shooting at a mall may develop an intense fear of returning to that or another mall.
• 4.
  A heightened arousal develops that may resemble a startle response when none is warranted. For example, a Vietnam veteran with PTSD may become hostile toward a Vietnamese emigrant now living in the United States.

Perhaps no generation has received as much attention to the consequences of PTSD as the generation who fought in the Vietnam War. It has been [Page 45]estimated that as many as 20% of Vietnam War veterans experienced PTSD, and a majority of these individuals receive income from the Veterans Administration for disability because of their illness and inability to work.

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