PTSD, Trauma & Stress Disorders

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In the history of psychiatry, the First World War is often identified with the rise of the disorder of “shellshock.” However, many in both the medical community and the military establishment were dubious of the claim that war could produce psychiatric symptoms.

Augustine

It is clear from a 21st century psychiatric perspective that Augustine was suffering from PTSD, but Augustine was victimized in ways far more horrific than filmmaker Alice Wincour revealed. More in this film review by Alan Stone, MD.

This child's behaviors suggested ADHD-combined or primarily hyperactive type and conduct disorder. However, there was a strong history of trauma and affective disturbance. A structured interview format indicated that he formally met criteria for both PTSD and mixed episode. Without this format, features defining these disorders might have been missed and the child treated only for ADHD.

About a year ago, I wrote the blog “Are Dogs Man's Best Therapist?” To my surprise, it turned out to be a very popular one. Since then, dogs continue to be in the news for their therapeutic effect, including being brought to Newtown right after the mass murder there.

James Dao reports in the New York Times that the military is considering 2 steps to reduce its startling rate of active duty suicides-which is approaching an unacceptable one suicide every day. Both measures are completely sensible, but neither goes nearly far enough.

With understandable urgency, Secretary of Defense Leon Panetta has made suicide one of his top priorities, instructing commanders at all levels to feel acutely accountable for it. The numbers are startling. On average 1 active duty soldier is killing himself each day--twice the number of combat deaths and twice the civilian rate.

Apathy is our enemy. Pain, paradoxically, is our ally because it is one of the most powerful fuels we have to impel us to a different and better tomorrow.

The first half of the 20th century saw 2 world wars, indiscriminate aerial bombing of civilians, the dropping of the atomic bomb, and the Holocaust-all of which created intense trauma for soldiers and civilians.Yet it was not until the American intervention in a post-colonial civil war in Southeast Asia that the psychiatric community in the 1970s formally described what we now call PTSD.

In preparing DSM-IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts.

When counseling trauma victims and patients with PTSD, do you ask them to retell the trauma or do you think this prolongs it?

Exposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.