United States Department of Veterans Affairs
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 individual weakness (i.e., a traumatic neurosis). The key to understanding the scientific basis and clinical expression of PTSD is the concept of "trauma."
In its initial DSM-III formulation, a traumatic event was conceptualized as a catastrophic stressor that was outside the range of usual human experience. The framers of the original PTSD diagnosis had in mind events such as war, torture, rape, the Nazi Holocaust, the atomic bombings of Hiroshima and Nagasaki, natural disasters (such as earthq...