Post traumatic stress disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Synonyms and keywords: PTSD

Cultural aspects

Veterans and politics

Early cases of the disorder were recognized after World War I, including individuals treated by Sigmund Freud. The diagnosis was removed from DSM-II, which resulted in the inability of Vietnam veterans to receive benefits for this condition. In part through the efforts of Chaim F. Shatan, who coined the term post-Vietnam Syndrome, the condition was added to the DSM-III as posttraumatic stress disorder.

In the United States, the provision of compensation to veterans for PTSD is under review by the Department of Veterans Affairs (VA). The review was begun in 2005 after the VA had noted a 30% increase in PTSD claims in recent years. The VA undertook the review because of budget concerns and apparent inconsistencies in the awarding of compensation by different rating offices.

This led to a backlash from veterans'-rights groups, and to some highly-publicized suicides by veterans who feared losing their benefits, which in some cases constituted their only income. In response, on November 10, 2005, the Secretary of Veterans Affairs announced that "the Department of Veterans Affairs (VA) will not review the files of 72,000 veterans currently receiving disability compensation for post-traumatic stress disorder..."

The diagnosis of PTSD has been a subject of some controversy due to uncertainties in objectively diagnosing PTSD in those who may have been exposed to trauma, and due to this diagnosis' association with some incidence of compensation-seeking behavior. A psychiatry professor recounts an interview with a veteran who reported to a VA medical center after he had received a leaflet listing PTSD symptoms and encouraging affected veterans to apply for compensation. During the interview, the veteran complained to the psychiatrist of "survivor quilt." Asked what that was, he replied, "I don't know, Doc, but I've got it bad." It transpired that the leaflet had misprinted "survivor guilt" as "survivor quilt," and the veteran had quoted that symptom in his campaign to win PTSD compensation.

The matter of malingering is addressed by Brunet et al., who conclude that "All mental disorders are prone to malingering when there are secondary gains, and PTSD is no exception. However, in the case of PTSD, the reverse is also true": PTSD is often under-reported due to fear of associated stigma, a fear that is particularly high among emergency service workers and military personnel, and in societies where the traumatic event (e.g., sexual assault) may be associated with stigma.

While PTSD-like symptoms have been recognized in combat veterans of many military conflicts, the modern understanding of PTSD dates from the 1980s. Reported cases of combat-related PTSD from Operation Enduring Freedom and Operation Iraqi Freedom are being compiled in ePluribus Media's PTSD Timeline.

Canadian Veterans

Veterans Affairs Canada (VAC) is a new program including rehabilitation, financial benefits, job placement, health benefits program, disability awards and family support.

Law

If an individual suffering from PTSD commits a crime, there may be uncertainty about whether the individual can be held responsible for that act. In extreme cases, the defense of automatism, where the defendant was unable to control his actions, may be available. PTSD may produce an internal defect of reason within the meaning of the M'Naghten Rules (which defines the mental disorder defence in some criminal jurisdictions). The difference is that whereas defenses that rely on automatism result in an acquittal, since no guilt can be assigned to a party unable to control their actions; insanity or mental disorder leaves the "offender" available for sentencing by the court. In the event that a death has resulted, diminished responsibility may be available as an alternative to insanity. This defense reduces what would otherwise have been murder to manslaughter. In the specific instance of spousal abuse, this is often called battered woman syndrome and, more generally, the abuse defense in the U.S.

Related Chapters

• Acute stress reaction
• Anxiety Disorders Association of America
• Biological psychiatry
• Chemical imbalance theory
• Complex post-traumatic stress disorder
• Critical incident stress Management
• Dissociative disorders
• Dissociative identity disorder
• Edna B Foa
• Ego-state therapy
• EMDR
• Emotional dysregulation
• List of counseling topics
• Mental health
• Post-abduction syndrome
• Post-abortion syndrome
• Prolonged exposure therapy
• Psychogenic amnesia
• Psychoneuroimmunology
• Somatic Experiencing
• Survivor syndrome
• Trauma model of mental disorders

Further reading

• MDMA-Assisted Psychotherapy for the Treatment of Post-Traumatic Stress Disorder Chapter 8 in Psychedelic Medicine: New Evidence for Hallucinogens as Treatment. Michael Winkelman and Thomas B. Roberts (editors) (2007) Westport, CT: Praeger/Greenwood.
• Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops, by Ilona Meagher, Introduction by Penny Coleman, Foreword by Robert Roerich, M.D.
• A War of Nerves. Soldiers and psychiatrists 1914-1994 by Ben Shephard. Jonathon Cape: London 2000. 475 pp. Written by UK historian and producer, presents as a well researched, easy to read book with ++ references. Traces history of PTSD as a diagnosis wrt war service, as a problem for many: sufferer, psychiatrists both military and non-military, strategists, war office and politicians etc in various countries using eg patient accounts, war office accounts from doctors and military/political figures.