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How has the awareness and diagnostic process for PTSD changed over time?

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How has the awareness and diagnostic process for PTSD changed over time?

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- The Industrial Revolution led to a rise in cases of PTSD outside of the battlefield (railway disasters for example)
- It was thought that these symptoms were caused by microscopic lesions in the spine or brain ("railway spine" or "railway brain")
- This concept lasted until WWI, when traumatic neurosis became a new diagnosis. In 1915, a French psychiatrist wrote that in the 88 mental disorder cases he witnessed, 20% of soldiers had a physical wound, while an important factor in all cases were fright and emotional shock.
- One treatment used commonly during WWI was electrical current (faradization)
- American psychiatrists contributed to combat psychiatry during WWII as they studied soldiers who were sent back to base hospitals.
- The Vietnam War caused an abundance of delayed PTSD from combat exposure. These profiles led to new diagnostic categories in DSM.

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From shell shock and war neurosis to posttraumatic stress disorder- a history of psychotraumatology

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- Mental disorders are subject to judgment and stigmatization
- Stigma is comprised of three levels: cognitive, emotional, and behavioral.
The concept of sigma on mental disorders was developed in the middle of the 20th century.
- This concept described how stigmatized people deal with their challenges.
- Self-stigma is the process in which someone with a  mental illness internalizes the stigma and limits the chances of recovery.
- Stigma before recent increased awareness would not only contribute to the severity of the mental illness but also suppress the public's awareness of mental disorders.

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Era prior to DSM
- Many conditions (named based on symptom and circumstance)referred to what is now considered PTSD
- WWII: Sodium Pentothal as a treatment for PTSD. Other preliminary efforts to facilitate PTSD
- The Korean War saw advances in combat psychiatry
- The Vietnam War practiced the three principles of immediacy, proximity, and expectancy in combat psychiatry.
- In 1974 Rape Trauma Syndrome was introduced in a revolutionary article analyzing interviews with female rape survivors
DSM era
- Brought Trauma-focused psychotherapies for PTSD
- Health Service was now available
- Pharmacotherapies provided antidepressants for PTSD candidates
- Combination of Pharmacotherapy and Psychotherapy has led to future therapies

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175 Years of Progress in PTSD Therapeutics- Learning From the Past

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Paper (written in 1983) on the psychological effects of Rape
- Describes rape within the category of PTSD based on DSM-III (1980)
- Rape until the 1970s thrived on misunderstanding and silence. Since then, more scientific. publications and understanding have increased its focus.
- The stress response patterns of rape victims are consistent with DSM-III within the category of anxiety disorders
- Three types of PTSD: acute disorder, compounded reaction to rape trauma, and unresolved sexual trauma
- Rape Trauma Syndrome has also been used in Court as a defense

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DSM-5 Diagnostic Criteria
- "A" stressor criterion
- "B" intrusive recollection criterion
- "C" avoidance criterion
- "D" negative cognitions and mood criterion
- "E" alterations in arousal and reactivity criterion
- "F" duration criterion
- "G" functional significance criterion
- "H" exclusion criterion
Most effective treatments
- Cognitive-behavioral therapy (CBT).
- Medication
- Other CBT approaches including prolonged exposure therapy and cognitive processing therapy (especially for sexual trauma)

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Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

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Historical evolution of PTSD diagnostic criteria
- Beginning with Freud's model of neurosis and Seduction Theory. Placed emphasis on external stressors.
- Freud then switched focus to analytic treatment for traumatic neurosis
- Freud's thinking led to the classification processes of DSM-I and DSM-II
- Modern diagnostics use the four diagnostic categories in DSM-IV

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The present study examined the evolution of the diagnostic criteria from the early writings of Sigmund Freud to the current DSM-IV. Freud's original model of neurosis, known as Seduction Theory, was a post-traumatic paradigm which placed emphasis on external stressor events. In 1897, due to a confluence of factors, he shifted his paradigm to stress intrapsychic fantasy as the focus of analytic treatment for traumatic neurosis. Freud's thinking influenced both the DSM-I and II classification of stress response syndromes as transient reactive processes. However, it is evident from his lectures in 1917-1918 that he understood the interrelatedness of what today is the four diagnostic categories in the DSM-IV.

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The historical evolution of PTSD diagnostic criteria: From freud to DSM-IV - Journal of Traumatic Stress

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The present study examined the evolution of the diagnostic criteria from the early writings of Sigmund Freud to the current DSM-IV. Freud's original model of neurosis, known as Seduction Theory, was a post-traumatic paradigm which placed emphasis on external stressor events.

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- Children and adolescents exposed to chronic trauma influences their development and ability to form relationships.
- Symptomatology: There is a variance in symptom presentation in children. The current focus is on reexperiencing, avoidance, and hyperarousal. The way in which a person manifests the symptoms changes as they mature. Some displays include: fears, separation anxiety, impulsivity, inattentiveness, isolation, enuresis, and encopresis.
- Current diagnostic criterion used for adults is less affective for diagnosing children.

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Historical Overview
- Psychological trauma and PTSD in particular have a short history in psychology
- Freud (1895) first hypothesized that traumatic experiences can lead to hysterical reactions. His "seduction theory" described how childhood sexual abuse resulted in a primitive defense mechanism including dissociation, denial, and repression. His therapeutic approach was to promote catharsis and abreaction, the precursor to cognitive-behavioral therapy (CBT)
- Early 20th century military combat led to advances in psychological theories on PTSD. ("shell-shock", nostalgia, war neurosis, combat fatigue, combat exhaustion)
- 1941: Kardiner formally explains traumatic reactions
- The First Wave of Behaviorism in the early 1900s. The classical conditioning theory led to the understanding of PTSD
- The Second Have of Behaviorism was the Cognitive Revolution in the mid to late 20th century. New cognitive theories backed by research led to new treatments for PTSD including EMDR (eye movement desensitization and reprocessing).
- Third Wave of Cognitive Behaviorism in the early 21st century has a focus on accepting the circumstances and internal experiences.

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Matthew J. Friedman, MD, PhD, is Executive Director of the National Center for PTSD, White River Junction VA Medical Center, and Professor of Psychiatry and Pharmacology, Dartmouth Medical School. He is a recipient of the International Society for Traumatic Stress Studies (ISTSS) Lifetime Achievement Award, among many other honors.ÿTerence M. Keane, PhD, is Director of the National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, where he is also Associate Chief of Staff for Research and Development, and Professor and Vice Chairman of Psychiatry at Boston University School of Medicine. He is a recipient of the ISTSS Lifetime Achievement Award, among many other awards.ÿPatricia A. Resick, PhD, is Director of the National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, and Professor of Psychiatry and Psychology at Boston University. She is a recipient of the ISTSS Robert S. Laufer Memorial Award for Outstanding Scientific Achievement. She is a past president of both the Association for Cognitive and Behavioral Therapies and the International Society for Traumatic Stress Studies and has won awards for her research.

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Unparalleled in its breadth and depth, this state-of-the-art handbook reviews current scientific advances in understanding trauma and PTSD, discusses the implications for clinical practice, and evaluates the status of evidence-based assessment and treatment. The foremost authorities in the field examine posttraumatic psychological reactions on multiple levels, from genes and neurocircuitry to gender and lifespan development.