Tuesday, January 24, 2023

When Was Ptsd First Discovered

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Battle Fatigue Or Combat Stress Reaction

Post-Traumatic Stress Disorder (PTSD) Mnemonics (Memorable Psychiatry Lecture)

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction , also known as “battle fatigue.” With long surges common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe “battle fatigue” was real. A good account of CSR can be found in Stephen Crane’s Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery.

Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using “PIE” principles. PIE required treating casualties without delay and making sure sufferers expected complete recovery so that they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

Battle Fatigue And Combat Stress

During WWII, British and American physicians used the terms combat stress reaction, combat stress, battle fatigue or exhaustion to describe traumatic stress responses to combat. Due to the stigma surrounding mental health conditions at the time, these terms were preferred because of the focus on combat, rather than psychiatric factors, as the cause of the condition we now know as PTSD.

Starting Jan 1 Provinces Workers Compensation Board Will Presume Condition Was Caused By Job

The Province of Manitoba will recognize post-traumatic stress disorder as a work-related disease starting Jan. 1.

Its the first time that PTSD has been included as an occupational disease by a Workers Compensation Board in Canada.

When a worker who has experienced a traumatic event on the job is diagnosed with PTSD, the Workers Compensation Board will presume his or her condition was caused by the job, making it much easier to access supports, treatment and compensation, Premier Greg Selinger said in a release.

The new bill extends coverage and benefits to all workers who are eligible for workers compensation in Manitoba and who are diagnosed with PTSD by medical professional.

This is compassionate, humane but smart legislation, said Selinger. It helps people suffering from PTSD no matter what area of work they are in.

Selinger said many people working in the provinces public service experience extreme stress, and the legislation will help get them support more quickly.

It is a well-established fact that PTSD is an illness that worsens over time if left untreated, said Michelle Gawronsky, the president of the Manitoba Government Employees Union the provinces largest union.

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Introduction Of Ptsd To The Dsm

PTSD was first mentioned in the DSM-I in the 1950s under the term gross stress reaction. Although this diagnosis included psychological problems related to traumatic events such as wartime combat, it limited symptoms to 6 months. Surprisingly, this diagnosis was removed from the DSM-II in 1968, representing a regression in accurate PTSD characterization.

The long-term psychological disabilities experienced by trauma survivors, including Vietnam veterans, sexual assault victims and Holocaust survivors led to the introduction of PTSD in the DSM-III in 1980. For the first time, the definition of PTSD in the DSM highlighted the critical connection between traumatic events and long-term psychological symptoms.

How Ptsd Went From Shell

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The symptoms of post-traumatic stress disorder have been recorded for millennia, but it took more than a century for physicians to classify it as a disorder with a specific treatment.

The battles were over, but the soldiers still fought. Flashbacks, nightmares, and depression plagued them. Some slurred their speech. Others couldnt concentrate. Haunted and fearful, the soldiers struggled with the ghosts of war.

Which war? If you guessed Vietnam, the U.S. Civil War, or even World War I, youd be wrong. These soldiers symptoms were recorded not on paper charts, but on cuneiform tablets inscribed in Mesopotamia more than 3,000 years ago.

Back then, the ancient soldiers were assumed to have been hexed by ghosts. But if they were treated today, they would likely receive a formal psychiatric diagnosis of post-traumatic stress disorder .

Although the diagnosis has its roots in combat, the medical community now recognizes that PTSD affects civilians and soldiers alike. Patients develop PTSD after experiencing, learning about, or witnessing a traumatic eventdefined as actual or threatened death, serious injury, or sexual violenceand their intrusive symptoms affect their ability to cope in the present.

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Diagnostic And Statistical Manual

PTSD was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a “trauma- and stressor-related disorder” in the DSM-5. The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.

Ptsd Past Present And Future

Imagine you have a flashback to the most terrifying moment youve ever experienced. Imagine you have nightmares, anxiety, depression, and panic attacks. You cant eat, you cant sleep, you can barely think. Imagine you are feeling isolated, alone, and confused. If you have PTSD you wont have to use your imagination, because this very well could be your reality.

The Mayo Clinic defines Post Traumatic Stress Disorder as a mental health condition triggered by a terrifying event. Symptoms include flashbacks, nightmares, insomnia, depression, and severe anxiety.

While most people are familiar with the term PTSD, a lot of people dont understand the full impact PTSD has made on our society and on veterans particularly. Here are some quick bullet points on PTSD to get everyone up to speed.

  • In America alone, 13 million people have PTSD
  • There are roughly 3 million new cases every year
  • Women are twice as likely to get PTSD
  • Theres no official cure, but treatment does help
  • One in three returning veterans will be diagnosed with PTSD
  • Less than 40% of these veterans will seek help
  • As high as 20% of Afghanistan and Iraq war veterans may currently have a post-traumatic stress disorder

Today theres a wealth of resources available for dealing with PTSD, but it wasnt always that way.

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Crimean War Years: 1853

  • Soldiers are frequently incapacitated with “irritable heart”, but no physical heart problems are found. They are treated with rest and light duties. :16
  • Many years after the end of the Crimean War, traumatized veterans are recognized as suffering from Da Costa syndrome or Effort syndrome, although neither name is used until long after the war. :455
  • 1860: The first understanding that a traumatic event could cause psychological as well as physical injury. People traumatized by accidents on railways were referred to as having Railroad Spinal Syndrome by the English surgeon Frederick Erichsen. :2, :624 Erichsen believed concussion of the spine to be the cause of the accident survivors’ “fear, fright and alarm”.:624 :10
  • 1863: Goya, a painter created Los Desastres de la Guerra to illustrate atrocities many of which he saw during the French invasion of Spain in 1808. :40
  • Post Traumatic Stress Disorder And The American Civil War

    How PTSD was first discovered. ð¥

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    War-induced psychological trauma in American soldiers was first observed during World War One. The physicians who diagnosed soldiers with shell shock, a form of war neuroses, believed it to have been the first time psychiatric ailments could be attributed to military service. They were wrong.

    Unidentified shell-shocked British WWI soldier, Wounded at Courcelette, 1916. Canadian War Museum, George Metcalf Archival Collection

    A Vietnam War soldier suffering emotional distress.

    But the main reason historians have been late to consider the problem of psychological harm among Civil War soldiers is that mid-nineteenth-century America lacked the scientific understanding that a traumatic experience, like warfare, could harm the mind, meaning they had no words to identify PTSD or shell shock, as medical caregivers in later wars did. Nor could they comprehend that a symptom like startle response to a loud noise, a reflexive action of fright conditioned by the sounds of battle was triggered by combat. Historians, therefore, have been justifiably cautious about studying Civil War combat disorders. Civil War doctors and soldiers themselves didnt see a connection between war and mental breakdowns, and left little direct evidence about psychological injuries. How could historians, working over 100 years later, and applying modern terms and diagnoses, confidently conclude that Civil War soldiers suffered the effects of war trauma?

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    Concussion Fright Or Malingering

    Etiology was a controversial question that was reflected by the choice of terms: shell shock or war neurosis? Soma or psyche? The now obsolete term shell shock, harking back to the vent du boulet of the Napoleonic wars, implied a somatic etiology, such as microscopic brain lesions due to a vascular, meningeal, white or gray matter concussion. Other diagnoses were also used to express the belief that the cause was more an emotional stressor, rather that a physical concussion. Such diagnoses were, for instance, war neurasthenia and war psychoneurosis, in France.

    Emil Kraepelin , without doubt one of the most influential psychiatrists of our times, wrote about his experience with war neuroses during WWI in his autobiography, published posthumously in German in 198315:

    Vietnam War Years: 1955

  • 1958: Venzlaff publishes a study of victims of Nazi persecution in Germany, suggesting that the extreme stress causes a “life event-based personality change”. Over 30 years later, in 1992, the World Health Organization adds Enduring Personality Change After Catastrophic Experiences to its ICD-10 diagnostic manual – this disorder is now known as Complex PTSD. :51
  • 1960: Harald Wolff questions the effect of catastrophic stress on lifespans, pointing out that uninjured U.S. veterans imprisoned by the Japanese had triple the rate of accidental death, and those who experienced the most severe stress had 7 times as many admissions to veteransââ¬â¢ hospitals. :50
  • 1961: Survivor syndrome is a term coined by Niederland, who emphasizes survivor guilt and the inability to grieve for those killed while in concentration camps. Eitinger notes the lowered capacity to tolerate stress in later life, and the additional Complex PTSD-like symptoms of survivors, including chronic anxiety, inability to experience pleasure or establish new interpersonal relationships, and reduced ability to work. :51
  • 1961: Denial of PTSD. Unrelated to war, Miller introduces the term Accident Neurosis which refers to PTSD symptoms as exaggerated or faked in order to gain compensation. Miller claims symptoms disappear once compensation is gained. :10-11
  • 1962: Dr Henry Kempe et al. publish The Battered Child Syndrome, describing post-traumatic symptoms in children. :5
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    The Mental Health Of First Responders

    The public has ignored for far too long the mental health of those who care for and rescue them. We have overlooked the fact that they are people first, people who can become depressed and stressed like anyone else.

    First responders have an image in public, and among each other that they are tough, rugged, and ready for any emergency. But, what if that paramedic, fireman, or nurse is also a survivor of childhood trauma and lives with the effects of complex post-traumatic stress disorder?

    The sturdy and unbreakable façade that many of those who are on the front lines of defending our lives leave them open for ridicule should they need to admit and seek help. They need to seek advice for stress, depression, or any of the myriad other mental health problems they may face.

    Molecular Mechanism And Predictive Factors

    PTSD

    The mechanisms leading to posttraumatic stress disorder have not yet been fully elucidated. Recent literature suggests that both the neuroendocrine and immune systems are involved in the formulation and development of PTSD . After traumatic exposures, the stress response pathways of the hypothalamicpituitaryadrenal axis and sympathetic nervous system are activated and lead to the abnormal release of glucocorticoids and catecholamines. GCs have downstream effects on immunosuppression, metabolism enhancement, and negative feedback inhibition of the HPA axis by binding to the GC receptor , thus connecting the neuroendocrine modulation with immune disturbance and inflammatory response. A recent meta-analysis of 20 studies found increased plasma levels of proinflammatory cytokines tumor necrosis factor-alpha , interleukin-1beta , and interleukin-6 in individuals with PTSD compared to healthy controls . In addition, some other studies speculate that there is a prospective association of C-reactive protein and mitogen with the development of PTSD . These findings suggest that neuroendocrine and inflammatory changes, rather than being a consequence of PTSD, may in fact act as a biological basis and preexisting vulnerability for developing PTSD after trauma. In addition, it is reported that elevated levels of terminally differentiated T cells and an altered Th1/Th2 balance may also predispose an individual to PTSD.

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    A Brief History Of Ptsd And How It Was Discovered

    We generally think of post-traumatic stress disorder as a modern affliction, but why is this? Despite changes in technology, science and our understanding of certain medical issues, the human condition has been largely the same since the beginning of time. Presumably, we can find out some information about the history behind PTSD. After all, isnt it reasonable that our ancestors would have suffered from PTSD at least the same amount if not more due to the more common hardships of the past?

    Historians tend to agree. In 2015, Smithsonian Magazine published a story about John Hildt, a Civil War soldier whose arm was shattered by musket fire during a pivotal battle in Virginia. After he received treatment for his lost limb, he was sent to an asylum with a case of acute mania.

    Medical records on cases like this are common, but these crude early diagnoses only hint at what patients were experiencing. Based on our understanding of what PTSD is, though, it certainly seems reasonable that these causes were caused by trauma, largely in the same way that PTSD develops today.

    World War Ii: Introduction Of Hypnosis To Treatment

    The use of hypnosis in the treatment of acute combat reactions was proposed because of the need for rapid therapy and the fact that early drug treatments were not helpful. Both the importance of recounting and recall and a posthypnotic suggestion for sleep were emphasized, as well as what could be described as the art and science of protocol therapy . Group psychotherapy for persons diagnosed with severe and acute anxiety states was recommended in 12 sessions over 4 weeks . One of the earliest follow-up studies described the outcomes of treatment:

    During the first year of operation we treated about 240 veterans of World War II who had been discharged because of neuropsychiatric disabilities. Psychotherapy, usually weekly interviews, was often supplemented by group therapy, pentothal and by social and environmental therapy, including coordination with various community resources.

    Another follow-up report, Traumatic War Neuroses Five Years Later , provides a nearly exact description of our current criteria for PTSD, including the following symptoms:

    Intense anxiety, recurrent battle dreams, startle reaction to sudden or loud noises, tension, depression, guilt, and a tendency to sudden, explosive, aggressive reactions a tendency to avoid people, fear of exposure to any type of criticism, difficulty in making decisions, and various types of sleep disturbances.

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    Ptsd And The Civil War

    The Civil War occurred before the age of modern psychiatry. At that time, the general consensus was that only weak-willed soldiers or persons with underlying health conditions suffered from PTSD. The horrific hand-to-hand combat was not considered a possible cause. Thus, Civil War PTSD was neither recognized nor treated at the time. However, detailed accounts of flashbacks, panic attacks, insomnia and suicidal thoughts were commonly documented among Civil War veterans.

    Understanding Ptsd In Your Life

    Invisible wounds: Living with post traumatic stress disorder (PTSD)

    If you or someone you love has experienced a trauma and would like to learn more about modern treatment and support, Black Bear Rehab can help. Our dedicated team of treatment experts can help you and those you love get back to feeling good again, despite past traumas. Now, more than ever, it is possible to heal from PTSD. Call us at to learn more.

    1 National Institute of Health. Post-Traumatic Stress Disorder. 30 June 2018.

    Black Bear Lodge is dedicated to providing the highest level of quality care to our patients. The Joint Commissions gold seal of approval on our website shows that we have demonstrated compliance to the most stringent standards of performance, and we take pride in our accreditation. The Joint Commission standards deal with organization quality, safety-of-care issues and the safety of the environment in which care is provided. If you have concerns about your care, we would like to hear from you. Please contact us at . If you do not feel that your concerns have been addressed adequately, you may contact The Joint Commission at: Division of Accreditation Operations, Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181, Telephone:

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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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    Timeline: The History Of Post

    Throughout history, there has been no smooth arc from ignorance to enlightenment in understanding the interplay of mind and body at work in traumain the American Civil War, medics diagnosed traumatized men with an ailment they termed “soldier’s heart,” blaming their psychological collapse on cardiac problems. The American Psychiatric Association created the post-traumatic stress disorder diagnosis in 1980, which sparked a proliferation of research. Below, we’ve charted the history of trauma that leads to that point. For more on trauma and a new kind of therapy that offers hope to sufferers, read our latest cover story.

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