United States Department of Veterans Affairs and Trauma

National Center for Post-Traumatic Stress Disorder

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POST-TRAUMATIC STRESS DISORDER: AN OVERVIEW

by Matthew J. Friedman, M.D., Ph.D.,

Executive Director, National Center for PTSD

Professor of Psychiatry and Pharmacology, Dartmouth Medical School

The risk of exposure to trauma has been a part of the human condition since we have evolved as a species. Attacks by saber tooth tigers or twentieth century terrorists have probably produced similar psychological sequelae in the survivors of such violence. Shakespeare's Henry IV appears to have met many, if not all, of the diagnostic criteria for post-traumatic stress disorder (PTSD), as have other heroes and heroines throughout the world's literature. The history of the development of the PTSD concept is described by Trimble (1985).

In 1980, the American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme. Although a controversial diagnosis when first introduced, PTSD has filled an important gap in psychiatric theory and practice. From an historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual him or herself (i.e., the traumatic event) rather than an inherent

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ions of the original event have the power to evoke mental images, emotional responses, and psychological reactions associated with the trauma. Researchers, taking advantage of this phenomenon, can reproduce PTSD symptoms in the laboratory by exposing affected individuals to auditory or visual traumamimetic stimuli (Keane, et. al., 1987). The "C" or avoidant/numbing criterion consists of symptoms reflecting behavioral, cognitive, or emotional strategies by which PTSD patients attempt to reduce the likelihood that they will either expose themselves to traumamimetic stimuli, or if exposed, will minimize the intensity of their psychological response. Behavioral strategies include avoiding any situation in which they perceive a risk of confronting such stimuli. In its most extreme manifestation, avoidant behavior may superficially resemble agoraphobia because the PTSD individual is afraid to leave the house for fear of confronting reminders of the traumatic event(s). Dissociation and psychogenic amnesia are included among avoidant/numbing symptoms by which individuals cut off the conscious experience of trauma-based memories and feelings. Finally, since individuals with PTSD cannot tolerate strong emotions, especially those associat
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Approximate Word count = 2292
Approximate Pages = 9 (250 words per page)