PTSD+History+&+Etiology

**History of PTSD**

People have experienced very stressful, life-threatening events for centuries. Therefore it is known that Posttraumatic Stress Disorder is a condition that has impacted humans for a very long time, although not by the formal DSM diagnosis of posttraumatic stress disorder. Very early on, PTSD would have been viewed as someone simply being weak or cowardly and was not recognized as a medical condition. Throughout history PTSD has usually been associated with war and has sometimes been referred to as battle fatigue or gross stress reaction (used after World War II), combat fatigue or shell shock (used after World War I), and soldier’s heart (used after the Civil War).  The Vietnam War brought significant attention back to PTSD as a legitimate emotional disorder as doctors began diagnosing soldiers with post-Vietnam syndrome. It was not until 1980 when PTSD was formally introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), as an anxiety disorder. PTSD was recognized in previous editions of the DSM, but not as a distinct disorder. In the first edition it was known as stress response syndrome and was listed under the heading of gross stress reactions. In the second edition trauma related disorders were listed as situational disorders. In the most recent version of the DSM-IV, PTSD has been classified as a new stress response category.

Although the history of PTSD is based on combat related trauma, there are many other contributing sources of trauma that can cause PTSD. Today, about 7-8% of the general population will develop PTSD, whereas veterans will have rates of PTSD ranging from 10-30% (Beall, 1997).

**Etiology of PTSD**

PTSD is caused by exposure to various types of trauma. Typically, the types of trauma experienced in Post Traumatic Stress Disorder would be considered overwhelming and traumatic for anyone exposed to them. Below are a few examples of the types of trauma that one may be directly or indirectly affected by:

A direct, first-hand experience can cause the type of severe trauma reaction seen in PTSD. Traumatic events directly experienced may include but are not limited to:
 * Military combat
 * Violent personal assault (including physical and sexual abuse)
 * Being kidnapped [[image:AftermathFiremenDebrisAP.jpg width="459" height="198" align="right"]]
 * Being taken hostage
 * Terrorist attack
 * Torture
 * Natural or Man-Made Disasters
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Severe accidents
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">House fires
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Being diagnoses with a life-threatening illness

<span style="font-family: Georgia,serif; font-size: 120%;">Witnessed events can cause PTSD as well. Watching the plight of others who are in danger, or who are seriously injured or killed, can also cause PTSD. <span style="font-family: Georgia,serif; font-size: 120%;">Traumatic events that are witnessed may include, but are not limited to:
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Observing the serious injury/death of another person due to:
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Violent assault
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Accidents
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">War
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Disasters
 * <span style="font-family: Georgia,serif; font-size: 120%;">Unexpectedly witnessing a dead body or body parts

<span style="font-family: Georgia,serif; font-size: 120%;">A third type of exposure occurs for some through learning about traumatic events that others have experienced. <span style="font-family: Georgia,serif; font-size: 120%;">Traumatic events that are learned about may include, but not be limited to: <span style="font-family: Georgia,serif; font-size: 120%;">(Grinage, 2003)
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Violent personal assault
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Serious accident
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Serious injury experienced by a significant other
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Learning about a sudden unexpected death of a significant other

<span style="font-family: Georgia,serif; font-size: 120%;">It is important to note that not everyone who lives through a dangerous and/or traumatic event will get PTSD. In fact, most will not get the disorder. In addition to the nature of the trauma, researchers have identified many other factors that also influence whether or not a person will get PTSD.

<span style="font-family: Georgia,serif; font-size: 120%;">Risk factors for PTSD may include, but not be limited by:
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Living through dangerous events and traumas (including physical/sexual abuse in childhood)
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Having a history of mental illness
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Getting hurt
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Seeing people hurt or killed
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Feeling horror, helplessness, or extreme fear
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Having little or no social support after the event
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job.

<span style="font-family: Georgia,serif; font-size: 120%;">Researchers have also identified factors known as resilience factors, which can help protect an individual from developing PTSD. <span style="font-family: Georgia,serif; font-size: 120%;">Resilience factors that may reduce the risk of PTSD may include, but not be limited by: <span style="font-family: Georgia,serif; font-size: 120%;">(Centre for the Treatment and Study of Anxiety, 2011)
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Seeking out support from other people, such as friends and family
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Finding a support group after a traumatic event
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Feeling good about one's own actions in the face of danger
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Having a coping strategy, or a way of getting through the bad event and learning from it
 * <span style="font-family: Georgia,serif; font-size: 120%; vertical-align: middle;">Being able to act and respond effectively despite feeling fear.

<span style="color: #9b0404; font-family: Georgia,serif; font-size: 150%;">**Differential Diagnosis of Posttraumatic Stress Disorder**

<span style="font-family: Georgia,serif; font-size: 120%;">While the symptoms of posttraumatic stress disorder may seem similar to those of other disorders, there are distinct differences as you will see below: <span style="font-family: Georgia,serif; font-size: 120%;">Obsessive-Compulsive Disorder (recurring intrusive thoughts are not directly trauma related) || <span style="font-family: Georgia,serif; font-size: 120%;">(Psychiatry Online, 2003)
 * <span style="font-family: Georgia,serif; font-size: 120%;">Depression after trauma (numbing and avoidance may be present, but not hyper arousal or intrusive symptoms) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Panic Disorder (if panic attacks are not limited to reminders or triggers of the trauma) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Generalized Anxiety Disorder (may have symptoms similar to PTSD hyper arousal) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Agoraphobia (if avoidance is not directly trauma related) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Specific Phobia (if avoidance is not directly trauma related) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Adjustment Disorder (usually has less severe stressor and different symptoms) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Acute Stress Disorder (if less than 1 month has elapsed since trauma) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Dissociative Disorders (if prominent dissociative symptoms are present) ||
 * <span style="font-family: Georgia,serif; font-size: 120%;">Factitious Disorders or malingering (especially is secondary gain is apparent)