Post-Traumatic Stress Disorder

Events that occur during a war are far from the range of normal everyday experiences. These sights, sounds and memories can cause veterans to have problems following their time in the war zone.  

It appears particularly unsettling for troops to go from a war zone back to 'The World' almost overnight. Vietnam GI's were typically transferred alone, separate from their units, and often found themselves in a combat zone one day and back in the U.S. a day or two later. That's a sharp contrast to World War Two when most soldiers shipped home with their units on troop transports, allowing the soldiers a couple weeks to process their war memories and 'decompress.'

Prior to the Vietnam War, there were several names for PTSD: neurasthenia, shell shock, war neurosis, and combat fatigue.  Following the Vietnam War, the term "Post-traumatic Stress Disorder" was coined.

One of the most promising therapies for victims of PTSD is known as "EMDR - Eye Movement Desensitization and Reprocessing."  Psychologist Francine Shapiro of the Mental Research Institute in Palo Alto, California, discovered the technique by chance.   She went on to do an initial study with 22 victims of trauma, using a technique where the patient follows an object which she moves back and forth with her hand, mimicking the movement of a slow windshield wiper on an automobile.  It worked!

"Traumatic feelings and pictures from earlier life experiences become locked in the nervous system in their original disturbing form," she says.  "Perhaps EMDR unlocks them because the eye movements in EMDR are similar to eye movements that happen during REM (rapid eye movement) sleep, which is when the brain processes disturbing memories.   In a waking state, EMDR may stimulate reprocessing of traumatic memories and their associated thoughts and feelings by opening up a network of traumatic memories to input from the conscious mind...."

(See the September 1994 issue of AMERICAN  HEALTH magazine for the entire article)

 PTSD diagnostic criteria from the DSM-III

Post-traumatic Stress Disorder (309.89)

Essential feature. Characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The original stressor is usually experienced with intense fear, terror, and/or helplessness. 

The precipitating stressor must not be one which is usually well tolerated by most other members of the cultural group (e.g., death of a loved one, ordinary traffic accident). Post-traumatic Stress Disorder need not develop in every victim. Traumas may be experienced alone, e.g., rape, severe physical assault) or in groups (e.g., military combat, unusually serious automobile accidents). The stressor may arise from natural, accidental, or purposeful events.

Age-specific features. The disorder in children may present differently (see below).

Associated features. Depression and anxiety are common and may be diagnosed as separate disorders. Compulsive behavior or changes of routine or lifestyle may occur. Pseudo -"organic" symptoms, such as memory problems, difficulty in concentrating, or emotional lability, may occur and may be confused with Somatoform Disorders. "Survivor's guilt" may occur, particularly if others were killed in the traumatic event. Impairment may be mild or severe and may affect almost any aspect of life. Phobic avoidance of real or symbolic reminders of the trauma may occur.

Differential diagnosis: If criteria for Anxiety Disorders, Depressive Disorders, or Organic Mental Disorders are fully met, these diagnoses should also be made. "Adjustment Disorder" implies a less severe trauma, and the patient does not meet all of the criteria listed below.

Diagnostic criteria for Post-Traumatic Stress Disorder:

A. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1. recurrent and intrusive, distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)

2. recurrent distressing dreams of the event

3. sudden acting or feeling as if the traumatic event were recurring (including "flashback" or dissociative episodes, whether or not intoxicated)

4. intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness, as indicated by at least three of the following:

1. efforts to avoid thoughts or feeling associated with the trauma

2. efforts to avoid activities or situations that arouse recollections of the trauma

3. inability to recall an important aspect of the trauma (psychogenic amnesia)

4. markedly diminished interest in significant activities (in young children, loss of recently acquired developmental skills such as toilet training or language skills)

5. feeling of detachment or estrangement from others

6. restricted range of affect

7. sense of foreshortened future (e.g., the patient does not expect to live very long or to have a successful career)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

1. difficulty falling or staying asleep

2. irritability or outbursts of anger

3. difficulty concentrating

4. hypervigilance

5. exaggerated startle response

6. physiological activity upon exposure to events that symbolize or resemble an aspect of the traumatic event

E. Duration of disturbance (symptoms in "B," "C," and "D") of at least one month.

Specify: "delayed onset" if symptom onset occurs at least six months after the traumatic event. Age-specific features. The disorder in children may present differently.


VVA's Guide on PTSD


REmilitary PTSD Summary

National Center for PTSD