Understanding the History of PTSD

Post-traumatic stress disorder (PTSD) is when shocking or traumatic events, accidents, and disasters have a lasting effect on a person's well-being. PTSD symptoms can include flashbacks, anxiety, and frightening thoughts, all of which can be triggered by situations in everyday life, such as loud noises or a person who ignites a memory. Most people who experience a traumatic event don't develop PTSD, but for those who do, PTSD can go away on its own in the months after a shocking event, or it can become chronic and last for years.

This article covers the history of PTSD as a diagnosis, how the condition is understood today, and PTSD symptoms and treatment.

PTSD and War

Symptoms of post-war PTSD, like nightmares and flashbacks, are mentioned in ancient works by scholars like Hippocrates. Scientific research in the U.S. about war's effect on soldiers likely began during the Civil War.

During World War I, British soldiers began using the term "shell shocked" when a soldier was unable to battle because of symptoms like fatigue, tremors, nightmares, and confusion.

The term PTSD was first used during the Vietnam war. Researchers studied "post-Vietnam syndrome," the term for the psychological effects of the Vietnam war on soldiers. About 30% of Vietnam war veterans experience some form of PTSD in their lifetime.

PTSD can be caused by combat, losing comrades, and other stressors of war. Additionally, experiencing military sexual trauma (MST) such as sexual assault or harassment during war or combat training can also cause PTSD.

The Addition of PTSD to the Diagnostic and Statistical Manual of Mental Disorders (DSM)

PTSD as a diagnosis was partly born out of social movements in the 1970s that pushed for acknowledgment of trauma. The women's rights movement fought for recognition of the traumatic effects of rape and domestic abuse. Child abuse was also being discussed more openly at this time, and in 1974, congress passed the Child Abuse Prevention and Treatment Act, which supported mandatory reporting laws.

Researchers studying trauma noticed that symptoms could be similar in people, whether they were war veterans or survivors of rape, child abuse, natural disasters, accidents, and other traumas. PTSD officially became a recognized disorder in 1980, when it was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the American Psychiatric Association's manual of disorders.

The establishment of the PTSD diagnosis has helped in the scientific study of the condition, and in developing evidence-based methods to treat it.

Modern-Day Understanding and Diagnosis of PTSD

The latest update in the DSM's understanding of PTSD was in 2013 when the DSM-5 was released. Before the DSM-5, PTSD was classified as an anxiety disorder. Today, it is considered a trauma and stressor-related disorder.

Diagnostic criteria for PTSD looks at things like:

• Exposure to actual or threatened death, sexual violence, or injury
• Intrusive symptoms (like nightmares, flashbacks, etc.)
• Arousal symptoms (like angry outbursts, sleep issues, being easily startled)
  
• Alterations in mood or thinking
• Avoidance (i.e., avoiding memories/reminders of the trauma)

PTSD Symptoms

In addition to the exposure to the trauma, symptoms of PTSD fall into four categories which are as follows:

Intrusion symptoms:

• Nightmares
• Flashbacks
• Distress upon being reminded of the event

Avoidance symptoms:

• Avoiding thoughts and/or feelings about the traumatic event
• Avoiding things that remind a person of the traumatic event like situations, people, or certain places

Increased arousal:

• Being easily startled
• Difficulty concentrating
• Anger issues
• Sleep issues
• Reckless behavior

Negative changes in thoughts and feelings:

• Issues with memory
• Loss of interest in hobbies and previously enjoyed activities
• Feeling detached from others
  
• Difficulty feeling happy
  

PTSD Treatment

Treating PTSD can include medication, psychotherapy, or both. Treatment can vary depending on the effects of trauma and if there are any co-occurring conditions such as depression or substance abuse disorder.

Medications for treating PTSD can include certain anti-depressants and sleep aids. PSTD treatment can also include different types of psychotherapy, which can be done individually or in a group.

Trauma-Focused Therapies

Trauma-focused therapies for PTSD include:

• Cognitive processing therapy (CPT): A type of cognitive behavioral therapy (CBT) therapy focusing on changing the thoughts, ideas, and feelings you've had in relation to your trauma
• Prolonged Exposure (PE): Slowly facing your trauma-related feelings and memories while building increased tolerance
• Written exposure therapy: Writing about and discussing the traumatic event to rework the meaning the trauma has on you
• Narrative exposure therapy: Retelling a life story from birth, which can help those suffering from complex trauma
• Eye Movement Desensitization and Reprocessing (EMDR): Retelling a trauma while focusing on a sound or visual cue
• Brief Eclectic Psychotherapy (BEP): Combines cognitive behavioral and psychodynamic approaches to try and change painful thoughts and feelings related to a trauma

Other Psychotherapy for PTSD

Other types of psychotherapy that have been studied for PTSD include:

• Stress Inoculation Training (SIT): Focusing on developing skills to manage PTSD symptoms and other stress
• Present-Centered Therapy (PCT): Managing present-day issues affected by PTSD
  
• Interpersonal Psychotherapy (IPT): Focusing on improving interpersonal functioning impacted by trauma

Summary

PTSD symptoms have been discussed as an effect of war for thousands of years. During the U.S. Civil War, researchers began recording the effects of trauma on soldiers. In World War I, British soldiers referred to themselves as being too "shell shocked" to battle, which included symptoms of fatigue, confusion, and nightmares.

After the Vietnam war, U.S. healthcare providers diagnosed veterans as suffering from "post-Vietnam" syndrome. This, combined with greater awareness about the effects of rape, domestic abuse, and child abuse, eventually led to creating the PTSD diagnosis in 1980, with the release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), the American Psychiatric Association's manual of psychiatric disorders.

A Word From Verywell

Living with PTSD can be difficult, but it's important to know that your symptoms are understood by many and that you're not alone. The effects of overwhelming trauma have been acknowledged for thousands of years, and research on PTSD possibly spans hundreds of years. In other words, there is understanding and help available.

Considering the statistics, it's likely there are others in your area who can provide peer support as you navigate managing your own PTSD or helping a loved one with PTSD. So whether you're a veteran, a survivor of violence or abuse, or you've experienced serious injury, you, like many others before you, can enjoy life once again.