Exploring The History Behind Ptsd
Theres plenty of evidence to suggest that PTSD is nothing new in fact, theres nothing that refutes the idea that the condition has been with us since the dawn of man. The earliest humans likely faced trauma brought on by food insecurity and threats of violence from neighboring civilizations and animals.
Here are some other, non-war factors that may have contributed to PTSD and intense stress reactions in history:
- Disease: Its more than likely historical pandemics like the bubonic plague and the Spanish flu caused PTSD in some people. Even as recently as the early 20th century, polio, cholera and other chronic and deadly diseases caused great fear, loss and, ultimately, life-changing trauma.
- Slavery: From the Jewish slaves in Ancient Egypt to the African slaves in modern America, forced labor was and likely still is a source of trauma.
- Physical, Sexual and Domestic Abuse: A prominent source of PTSD and other mental health disorders today, abuse is not a 20th-century invention. Records of different types of abuse and mistreatment date back to some of the earliest written records.
Lessons To Be Learned
That Tom had a clear diagnosis of PTSD did not mean that there was a suitable EST that could be readily applied to him. However, there were some empirical findings about treating PTSD involving anxiety management and exposure that helped guide the therapy. It is now known that there are a variety of treatments that work for some forms of PTSD and that imaginal exposure is not as critical as was once assumed. This is why it is important that clinicians keep up with the empirical literature to maintain their expertise, as noted in the Section Clinical Expertise.
Diagnosis Of Complex Ptsd
While the concept of C-PTSD is longstanding, it is not in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders , and therefore isnt officially recognized by the American Psychiatric Association .
Although C-PTSD comes with its own set of symptoms, there are some who believe the condition is too similar to PTSD to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD.
There are mental health professionals who do recognize C-PTSD as a separate condition because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.
In 2018, the World Health Organization made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems .
Because the condition is relatively new and not recognized in the DSM-5, doctors may make a diagnosis of PTSD instead of complex PTSD. Since there is not a specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor.
Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.
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What Is Complex Ptsd
Complex post-traumatic stress disorder , is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms.
First recognized as a condition that affects war veterans, post-traumatic stress disorder can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.
When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD .
Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , the tool that mental health professionals use to diagnose mental health conditions.
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Ptsd In The Civil War
Nostalgia was a phenomenon noted throughout Europe and the disease reached American soil during the U.S. Civil War . In fact, nostalgia became a common medical diagnosis that spread throughout camps. But some military doctors viewed the illness as a sign of weakness and one that only affected men with a feeble willand public ridicule was sometimes the recommended cure for nostalgia.
While nostalgia described changes in veterans from a psychological perspective, other models took a physiological approach.
After the Civil War, U.S. doctor Jacob Mendez Da Costa studied veterans and found that many of them suffered from certain physical issues unrelated to wounds, such as palpitations, constricted breathing, and other cardiovascular symptoms. These symptoms were thought to arise from an overstimulation of the hearts nervous system, and the condition became known as soldiers heart,irritable heart, or Da Costas syndrome.
Interestingly, PTSD-like symptoms werent restricted to soldiers in the 1800s. During the Industrial Revolution, rail travel became more commonas did railway accidents.
Survivors of these accidents displayed various psychological symptoms , which collectively became known as railway spine and railway brain because autopsies suggested railway accidents caused microscopic lesions to the central nervous system.
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What Is The History Of Ptsd Diagnosis
The term post-traumatic stress disorder came into use in the 1970s in large part due to the diagnoses of U.S. military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders .
When did PTSD first get diagnosed?
PTSD first appeared as an operational diagnosis in DSM-III and was revised in DSM-III-R and DSM-IV . It made its first appearance in the ICD system later, in 1992.
The First Known Case Of Ptsd
For many years, trauma has been a topic of discussion due to the lasting impact it has had on soldiers returning from war. It has long been an accepted part of the human condition and part of how we react to troubling or tragic incidents. However, over time, there has been a shift in how we understand post-traumatic stress disorder. Now, multiple incidents of various kinds are known to cause post-traumatic stress.
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The Damage Caused By Ignoring Trauma And Its Effects
In a perfect world, we would approach PTSD at the source and provide comprehensive support for people who undergo trauma. Today, at least, we understand what PTSD is and have some effective methods of treating it.
In the past, the disease was little understood and the consequences were dire. Take John Hildt, the Civil War soldier from the beginning of this piece. He spent from 1862 to 1911 in an asylum, where he died. The lack of medical understanding about the circumstances that made him the way he was after the war caused the treatment community to chalk him up as unstable, and the lack of treatment did nothing to help him recover.
Given that people in history with PTSD didnt have access to the right methods of treatment, we can use known consequences of the condition to speculate as to what might have happened to these people. PTSD causes people to isolate themselves from their loved ones. It causes them to start abusing drugs and alcohol to cope with their pain. These factors increase the likelihood of becoming homeless. PTSD can also cause some suffering with it to develop other mental illnesses like depression and anxiety as a result, PTSD is linked with suicide.
This likely reality of historical PTSD cases is an unfortunate one. Without proper understanding and treatment, victims of trauma probably faced a much higher risk for a range of health problems, affecting their lives in a multitude of ways.
Diagnosis And Prevalence Of Posttraumatic Stress Disorder
The diagnosis of PTSD was first included in the third edition of the Diagnostic and Statistical Manual of Mental Disorder . At the time of introduction into the vernacular of mental health disorders, this diagnosis was meant to capture persistent and impairing fear-based reactions to stressors. In the newest edition of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition , trauma and stressor-related disorders were separated into a distinct category of diagnostic disorders to best capture the variety of emotional, cognitive, and behavioral responses that occur after exposure to a traumatic event. To meet criteria for a diagnosis of PTSD, a person must have experienced, witnessed, or have been confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. Examples of these types of events include experiencing a major disaster, serious accidents, or fire, being physically or sexually assaulted, seeing another person badly injured or killed, or experiencing war zone traumas.
G.H. Wynn, R.J. Ursano, in, 2017
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How The Understanding Of Ptsd Has Changed
Although most people link PTSD with post-war trauma, military combat is not the only event that can cause individuals to suffer from PTSD. Post-traumatic stress disorders can develop after any stressful, freighting or distressing event. Some types of events can include terrorist acts, serious auto accidents, sexual assault, pedestrian collisions, and any other incident that causes harm has been linked to PTSD in many survivors.
PTSD develops in about 1 of 3 people who experience severe trauma. Research is still needed to understand why some survivors develop the condition while others dont.
There are links to dissociation, depression, seasonal affective disorder, and more. These mental health conditions all impact the daily lives of the individuals dealing with PTSD. Because advocates for trauma victim frequently inform the public about PTSD, people are more aware of what it takes to heal. Therapy, medication, and other treatments exist to help those in need.
Post-traumatic stress disorder is nothing to ignore. For victims suffering with the condition, it is a constant reminder of the traumatic time in their lives. For the families of victims, it is something that requires attention and care. Dont let PTSD go untreated.
Here are some good resources you can use for more information about treatment and recovery:
Shell Shock And Combat Fatigue
From aerial combat to poison gas, WWI introduced terrifying new combat technology on a previously unimaginable scale, and soldiers left the front shattered. Seemingly overnight, the field of war psychiatry emerged and a new termshell shockappeared to describe a range of mental injuries, from facial tics to an inability to speak. Hundreds of thousands of men on both sides left World War I with what would now be called PTSD, and while some received a rudimentary form of psychiatric treatment, they were vilified after the war. As historian Fiona Reid notes, shell-shock treatment was constantly entwined with discipline in militaries that had trouble aligning their beliefs in courage and heroism with the reality of men who bore invisible wounds.
An American soldier in WWII suffering from “battle shock” is given a sedative by a medic. Terms like “battle shock,” psychiatric collapse, combat fatigue, and war neurosis were used to describe PTSD symptoms during World War II.
Military officials assumed that removing men from combat situations or treating them with injections of drugs such as sodium amytal would relieve their psychiatric distress. It didnt work: Nearly 1.4 million of the 16.1 million men who served in World War II were treated for combat fatigue during the war, and the condition was responsible for 40 percent of all discharges.
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The Davidson Trauma Scale
The Davidson Trauma Scale is a self-assessment that people can use to screen themselves for PTSD. This test uses a four-item scale called SPAN that looks at four key areas involved in PTSD: startle, physiological arousal, anger, and emotional numbness. This test has 17 items and asks the person taking it to rate the severity of each symptom across the SPAN categories.
Prehistory Of Complex Ptsd
In a milestone book, Judith Lewis Herman summarized her clinical research with victims of domestic and sexualized violence, including child sexual abuse. She proposed a new diagnosis, which she called complex post-traumatic stress disorder . This diagnostic proposal had six symptom groups: Disturbance of affect regulation, alterations of consciousness, disturbed self-perception, disturbed perception of the offender, relationship problems, and changes in the value system. At the same time, Herman described a therapeutic framework approach that distinguishes three phases: security, remembering and grieving, and reconnection.
With a group of mainly child and adolescent psychiatrists and psychologists, van der Kolk developed the concept of Developmental Trauma Disorder and proposed it for introduction into the to be developed DSM. For children and adolescents, it was proposed as a definition that multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma leads to a pattern of psychopathological changes. This is described as a triggered pattern of repeated dysregulation in response to trauma cues , persistently altered attributions and expectancies , functional impairment . The DTD concept has been empirically investigated in several international studies, which led to a mixed picture of the validity and usefulness of this approach .
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A Brief History Of The Ptsd Diagnosis
The risk of exposure to trauma has been a part of the human condition since we evolved as a species. Attacks by saber tooth tigers or twenty-first century terrorists have probably produced similar psychological sequelae in the survivors of such violence. Shakespeare’s Henry IV appears to meet many, if not all, of the diagnostic criteria for Posttraumatic Stress Disorder , as have other heroes and heroines throughout the world’s literature. The history of the development of the PTSD concept is described by Trimble .
In 1980, the American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders nosologic classification scheme . Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice. From an historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual rather than an inherent individual weakness . The key to understanding the scientific basis and clinical expression of PTSD is the concept of “trauma.”
In This Article
Importance of traumatic events
Revisions to PTSD diagnostic criteria
When To Get Medical Advice
It’s normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.
You should see a GP if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.
If necessary, your GP can refer you to mental health specialists for further assessment and treatment.
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Nostalgia Soldiers Heart And Railway Spine
Several alternative names have been used to describe trauma-linked stress disorders before the term post-traumatic stress disorder was coined. Swiss physician Dr. Johannes Hofer used the term nostalgia in the late 17th century to characterize soldiers who suffered from post-war symptoms such as anxiety, insomnia and homesickness.
TheIndustrial Revolution and the invention of the steam engine produced some of the first major human-made disasters. Physicians, confused by psychological symptoms displayed by survivors of major railway disasters, believed that the signs were caused by microscopic lesions on the spine or brain. This belief gave rise to the term railway spine. The term soldiers heart was coined after the Civil War by a doctor in Philadelphia, Dr. Jacob Mendes Da Costa, after mistaking post-combat psychological symptoms for a cardiac condition.
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War And Emotional Trauma
Although PTSD can arise after a variety of traumatic events, war trauma made a substantial contribution to the current conceptualization of PTSD. While the terminology for PTSD only appeared in the psychiatricclassification system in 1980, knowledge of battle-related psychological problems goes back to antiquity. Mythical Greek heroes Ajax and Hercules both succumbed to their emotional wounds, not injuries of combat. In 1688, Swiss physician Johannes Hoferwrote about an unusual grouping of symptoms in Swiss mercenaries fighting in France or Italy, which he termed nostalgia. Irritable heart, also called soldiers heart or Da Costas syndrome, was described in soldiersof the American Civil War by Jacob Mendes Da Costa, an American physician.The syndrome, a forerunner of PTSD, included unexplained cardiac symptoms, such as palpitations,chest pain and shortness of breath .
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Reducing The Stigma On Ptsd Means Understanding It
So, when did we start acknowledging PTSD for what it is instead of treating it as a defect brought on in weak men by battle or as symptom of a person who is unfit to fight? And why did this change occur over time? The answer is relatively simple.
Over time, we began to better understand the mechanisms at work in mental health conditions. Society began to realize that anyone can be affected by depression, anxiety, PTSD or any other condition. This coincided with a better system of studying the positive effects and the risks of certain treatments, developing a knowledge base of effective treatment for mental health disorders.
Today, were definitely getting to the point where PTSD is widely understood and accepted hopefully, the trend in both of these areas continues. With that in mind, though, treatment is more available than ever before. At FHE Health, were here to help. Contact us today to learn about your options if youre suffering from PTSD.
Nostalgia Soldier’s Heart And Railway Spine
Prior to U.S. military efforts, Austrian physician Josef Leopold wrote about “nostalgia” among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.
A second model of this condition suggested a physical injury as the cause of symptoms. “Soldier’s heart” or “irritable heart” was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these “cardiac” symptoms and described it as overstimulation of the heart’s nervous system, or “Da Costa’s Syndrome.” Soldiers were often returned to battle after receiving drugs to control symptoms.
The thought that physical injury led to PTSD-like symptoms was supported by European reports of “railway spine.” As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.
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