A Harvest of Psychiatric Disorders
PTSD: A Breakthrough in Diagnosis
In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.
Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.
So who is likely to develop PTSD following a traumatic experience, and why? The answer is not yet clear, but it now appears that PTSD represents a failure of the body to extinguish or contain the normal nervous system response to stress. This failure is associated with many factors:
- the nature and severity of the traumatic event
- preexisting risk factors related to previous exposure to stress or trauma, particularly in childhood
- the individual’s history of psychological and behavioral problems, if any
- the person’s level of education, and other cognitive factors
- family history—whether parents or other relatives had anxiety, depression, or PTSD
People who develop PTSD are also more likely to develop other psychiatric disorders involving mood (depression, anxiety and panic, bipolar disorder), personality, eating, and substance dependence.
People also seek medical help for problems that may develop after the trauma that can mask or intensify PTSD symptoms. These symptoms include chronic pain, fatigue, headaches, muscle cramps, and self-destructive behavior, including alcohol or drug abuse and suicidal gestures. Often, survivors are not aware that their physical symptoms are related to their traumatic experiences. They may even fail to mention those disturbing events to their physicians, which can make PTSD difficult to diagnose accurately.