When was ptsd identified

Long before the dawn of modern psychiatry, people and situations depicting PTSD may have been recorded in early works of literature.

For example, in the Epic of Gilgamesh , the earliest surviving major work of literature dating back to B. Later, in a B. This blindness, brought on by fright and not a physical wound, persisted over many years. Other ancient works, such as those by Hippocrates , describe soldiers who experienced frightening battle dreams. In the Indian epic poem Ramayana , likely composed around 2, years ago, the demon Marrich experiences PTSD-like symptoms, including hyper-arousal, reliving trauma, and avoidance behavior, after nearly being killed by an arrow.

Marrich also gave up his natural duty of harassing monks and became a meditating recluse. In the last several hundred years, medical doctors have described a few PTSD-like illnesses, particularly in soldiers who experienced combat. In the late s, Swiss physician Dr. Around the same time, German, French and Spanish doctors described similar illnesses in their military patients.

In , Austrian physician Josef Leopold Auenbrugger wrote about nostalgia in trauma-stricken soldiers in his book Inventum Novum.

The soldiers, he reported, became listless and solitary, among other things, and efforts could do little to help them out of their torpor. Civil War — In fact, nostalgia became a common medical diagnosis that spread throughout camps. While nostalgia described changes in veterans from a psychological perspective, other models took a physiological approach. After the Civil War, U. During the Industrial Revolution , rail travel became more common—as did railway accidents. The term itself first appeared in the medical journal The Lancet in Feb.

Charles Myers of the Royal Army Medical Corps documented soldiers who experienced a range of severe symptoms—including anxiety, nightmares, tremor, and impaired sight and hearing—after being exposed to exploding shells on the battlefield. It appeared that the symptoms resulted from a kind of severe concussion to the nervous system hence the name.

By the following year, however, medical and military authorities documented shell shock symptoms in soldiers who had been nowhere near exploding shells. There were some 80, cases of shell shock in the British army alone by the end of the war. Up to half of military discharges during the war may have been related to combat exhaustion, according to the National Center for PTSD. If an individual meets diagnostic criteria for PTSD, it is likely that he or she will meet DSM-5 criteria for one or more additional diagnoses Most often, these comorbid diagnoses include major affective disorders, dysthymia, alcohol or substance abuse disorders, anxiety disorders, or personality disorders.

There is a legitimate question whether the high rate of diagnostic comorbidity seen with PTSD is an artifact of our current decision-making rules for the PTSD diagnosis since there are not exclusionary criteria in DSM In any case, high rates of comorbidity complicate treatment decisions concerning patients with PTSD since the clinician must decide whether to treat the comorbid disorders concurrently or sequentially.

PTSD is no longer considered an Anxiety Disorder but has been reclassified as a Trauma and Stressor-Related Disorder because it has a number of clinical presentations, as discussed previously. In addition, two new subtypes have been included in the DSM The Dissociative Subtype includes individuals who meet full PTSD criteria but also exhibit either depersonalization or derealization e.

The Preschool Subtype applies to children six years old and younger; it has fewer symptoms especially in the "D" cluster because it is difficult for young children to report on their inner thoughts and feelings and also has lower symptom thresholds to meet full PTSD criteria. Questions that remain about the syndrome itself include: what is the clinical course of untreated PTSD; are there other subtypes of PTSD; what is the distinction between traumatic simple phobia and PTSD; and what is the clinical phenomenology of prolonged and repeated trauma?

With regard to the latter, Herman 14 has argued that the current PTSD formulation fails to characterize the major symptoms of PTSD commonly seen in victims of prolonged, repeated interpersonal violence such as domestic or sexual abuse and political torture. She has proposed an alternative diagnostic formulation, "complex PTSD," that emphasizes multiple symptoms, excessive somatization, dissociation, changes in affect, pathological changes in relationships, and pathological changes in identity.

Although this formulation is attractive to clinicians dealing with individuals who have been repeatedly traumatized, scientific evidence in support of the complex PTSD formulation is sparse and inconsistent. It is possible that the Dissociative Subtype, which has firm scientific support, will prove to be the diagnostic subtype that incorporates many or all of the symptoms first described by Herman.

PTSD has also been criticized from the perspective of cross-cultural psychology and medical anthropology, especially with respect to refugees, asylum seekers, and political torture victims from non-Western regions. Some clinicians and researchers working with such survivors argue that since PTSD has usually been diagnosed by clinicians from Western industrialized nations working with patients from a similar background, the diagnosis does not accurately reflect the clinical picture of traumatized individuals from non-Western traditional societies and cultures.

It is clear however, that PTSD is a valid diagnosis cross-culturally On the other hand, there is substantial cross-cultural variation and the expression of PTSD may be different in different countries and cultural settings, even when DSM-5 diagnostic criteria are met The most successful interventions are cognitive-behavioral therapy CBT and medication. Excellent results have been obtained with CBT approaches such as prolonged exposure therapy PE and Cognitive Processing Therapy CPT , especially with female victims of childhood or adult sexual trauma, military personnel and Veterans with war-related trauma, and survivors of serious motor vehicle accidents.

Other antidepressants are also effective and promising results have recently been obtained with the alpha-1 adrenergic antagonist, prazosin A frequent therapeutic option for mildly to moderately affected PTSD patients is group therapy, although empirical support for this is sparse.

In such a setting, the PTSD patient can discuss traumatic memories, PTSD symptoms, and functional deficits with others who have had similar experiences. It is important that therapeutic goals be realistic because, in some cases, PTSD is a chronic, complex e. Resick, Nishith, and Griffin have shown however, that very good outcomes utilizing evidence-based Cognitive Processing Therapy CPT can be achieved, even with such complicated patients 19 ; and, more recently, group CPT has shown promising results A remarkable recent finding is the effectiveness of group CPT, adapted for illiteracy and risk of ongoing violence, with sexual trauma survivors in the Democratic Republic of Congo The hope remains, however, that our growing knowledge about PTSD will enable us to design other effective interventions for patients afflicted with this disorder.

There is great interest in rapid interventions for acutely traumatized individuals, especially with respect to civilian disasters, military deployments, and emergency personnel medical personnel, police, and firefighters.

This has become a major policy and public health issue since the massive traumatization caused by the September 11 terrorist attacks on the World Trade Center, Hurricane Katrina, the Asian tsunami, the Haitian earthquake, the wars in Iraq and Afghanistan and other large-scale traumatic events.

Currently, there is controversy about which interventions work best during the immediate aftermath of a trauma. Research on critical incident stress debriefing CISD , an intervention used widely, has brought disappointing results with respect to its efficacy to attenuate posttraumatic distress or to forestall the later development of PTSD.

On the other hand, brief cognitive behavioral therapy has proved very effective in randomized clinical trials Friedman, M. Journal of Traumatic Stress, 26 , Brewin, C. Maercker, A. Kilpatrick, D. Go To Patient Version. As a result of all types of trauma, from natural disasters, to assault, or soldiers in battle, PTSD has been recognized as a human response to trauma and has been known by a number of explanations throughout history.

Mentions of combat stress can be found over 2, years ago in historical literature, and one of the first mentions can be found in a story of the battle of Marathon by Herodotus in fifth century Ancient Greece. Ancient tales of battle trauma and flashback-like dreams were documented by Hippocrates 4 BC , and Lucretius in the poem De Rerum Natura , which was written in 50 BC.

Even Shakespeare alluded to it in various plays, including his play Romeo and Juliet, in which Mercutio tells a lengthy account of Queen Mab, a character who creates dreams in the minds of men; who would wake men through dreams of battle and death. PTSD did not only occur in combat. Difficult living conditions gave way to trauma through other experiences. These early therapeutic interventions were the first step toward helping people who had survived traumatic events.

WWI brought a new awareness of traumatic effects of war. This condition described the same symptoms as PTSD and went on to become the predecessor of the official diagnosis. By the s, treatments became more humane, but many people would not admit to any trauma symptoms due to the stigma surrounding mental illness.