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Posttraumatic stress disorder

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Anxiety Disorders

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Abstract

In 1980, the APA added PTSD to the third edition of its DSM-III nosologic classification scheme. The DSM-III chose to define PTSD as a final common pathway occurring in response to many different types of catastrophic stressors, including burn injury, concentration camps, combat, and natural disasters. In fact, this approach was in opposition to the idea of the uniqueness of individual traumas such as “Vietnam syndrome” or “post-rape syndrome”. Although a controversial diagnosis when first introduced, the concept of PTSD is today regarded as having filled an important gap in neuropsychiatric theory and practice. The DSM-III diagnostic criteria for PTSD were revised in DSM-IIIR (1987) and DSM-IV (APA, 1994). Diagnostic criteria for PTSD include a history of exposure to a “traumatic event” and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms and hyperarousal symptoms. Another criterion concerns duration of symptoms (see Tab. 7.1). There are three subtypes of PTSD. The first is the acute subtype which corresponds to duration of symptoms of less than 3 months. The second is the chronic subtype which corresponds to a duration of symptoms of more than 3 months. The third subtype has a delayed onset, which corresponds to onset of symptoms at least 6 months following the stressor, but may be much later. Indeed, there have been cases in which PTSD re-emerged after 20, or even 40 years. PTSD is unique among other psychiatric diagnoses because of the great importance placed upon the etiologic agent, the traumatic stressor. In fact, one cannot make a diagnosis unless the patient has actually met the stressor criterion that means that he or she has been exposed to a historical event that is considered traumatic. Another hallmark is the alternation between re-experiencing and avoiding trauma-related memories. The memories that are particularly associated with PTSD appear rapidly and spontaneously, often intruding into consciousness with high frequency. The intrusive memories may consist of images accompanied by high levels of physiological arousal and are experienced as re-enactments of the original trauma (flashbacks). Flashbacks are qualitatively different from memories of the trauma which are retrievable through a normal search of long-term memory. They may be distinguished from normal memories by the original intensity of the emotions that accompany the flashbacks (Terr, 1991; Van der Kolk & Fisler, 1995).

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  1. 127 rue Henri Prou, Les Clayes Sous Bois, 78340, France

    Dr. Gérard Emilien

  2. Department of Pharmacology and Therapeutics, University College Cork, Ireland

    Prof. Timothy Dinan

  3. Kuopion Psykiatripalvelu Oy, Psychiatric Research Clinic of Kuopio, Asemakatu 46, Kuopio, FIN-70110, Finland

    Dr. Ulla Marjatta Lepola

  4. 23 Rue Raynouard, Paris, 75016, France

    Dr. Cécile Durlach

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Emilien, G., Dinan, T., Lepola, U.M., Durlach, C. (2002). Posttraumatic stress disorder. In: Anxiety Disorders. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8157-9_7

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