Post Traumatic Stress Disorder: Historical Perspective

1. Post Traumatic Stress Disorder: Historical Perspective John S Price, Ph.D. Psychological Services San Antonio Police Department

2. Combat Related Stress Injuries • Old problem but a new name • Greek and Roman References • 17th Century through US Civil War • Nostalgia • Soldier’ Heart

3. Combat Related Stress Injuries • World War I: Shell Shock • World War II: Combat Exhaustion or Battle Fatigue • 1973 Israelis: Battle Shock • Combat Stress Reaction

4. Combat Related Stress Injuries • DSM I: Hysteria • DSM II: Hysteria • DSM III: Acute Stress Disorder Post Traumatic Stress Disorder • DSM IV: Acute Stress Disorder Post Traumatic Stress Disorder

5. PTSD • ***A psychiatric disorder that can occur following the experience/witnessing of life threatening events such as: • Military Combat • Natural Disasters • Terrorist Incidents • Serious Accidents • Violent Personal Assaults: Such as Rape

6. PTSD • Can Include • Nightmares • Flashbacks • Difficulty Sleeping • Feeling Detached or Estranged • Can Impair Daily Life

7. PTSD • Occurs in Conjunction with Other Disorders • Such As: • Depression • Substance Abuse • Problems with Cognition • Physical or Mental Health Issues • Can Impair Ability to Function in Social or Family Life

8. PTSD • Estimated 7.8 % will experience PTSD at some point in their lives • Women (10.4%) twice as likely as men (5%) • About 3.6% of US Adults aged 18-54 (5.2 million) have PTSD during the course of a given year • 60.7% of men and 51.2% of women reported at least one traumatic event

9. PTSD • Events Most Associated with PTSD • Women • Rape • Sexual Molestation • Physical Attack • Threatened with a Weapon • Childhood Physical Abuse • Men • Rape • Combat Exposure • Childhood Neglect • Childhood Physical Abuse

10. PTSD • In a 2005 VA study of 168,528 veterans, 20% were diagnosed with psychological disorders, including 1,641 with PTSD • The Marines and Army were nearly 4x more likely to report PTSD than Navy or Air Force because of their greater exposure to combat situations • Enlisted men were twice as likely as officers to report PTSD

11. Combat Related Stress Injuries • World War I • Shell Shock • Nerveshock • Nerveshock Crisis • September 21, 1916 The German Association for Psychiatry convened a special “War Congress”

12. Combat Related Stress Injuries • After briefly discussing the evidence the “War Congress”, settled the debate by voting that persistent distress or functional impairment following exposure to a traumatic event could only in an individual with Hysteria

13. Combat Related Stress injuries • 1980 DSM III PTSD replaces Hysteria • Normalization model: PTSD is seen as a normal reaction to an abnormal situation

14. Combat Related Stress injuries • Stress Injuries as physical damage to the brain • Implications of returning to a Medical Model of stress injuries

15. Lori and I have been looking forward to attending the Pick-up Party; unfortunately we are having problems with car. We have a friend who also joined The Flock. If she is able to give a ride we will make the party otherwise we will have to wait until next week to pick up our wine John S Price Combat Related Stress Injuries • Questions