![]() The Department of Defense (DoD) and the Department of Veterans AffairsĪ1. The current diagnostic criteria, taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ( DSM-IV-TR), can be found in Box 2-1 (APA, 2000). ![]() Since 1980, PTSD has been the focus of much epidemiologic and clinical research, which in turn has led to modifications in the defining diagnostic criteria for PTSD. ![]() The findings contributed to the formal recognition of PTSD as a distinct disorder by the APA and later refining of the characteristic symptoms and diagnostic criteria. The NVVRS helped to illuminate PTSD as a signature wound of the Vietnam War and resulted in greater recognition of PTSD as a mental health disorder. The National Vietnam Veterans Readjustment Survey (NVVRS) was one of the first large-scale studies to examine PTSD and other combat-related psychologic issues in a veteran population (Kulka, 1990). It was not until after the Vietnam War that research and methodical documentation of what was then termed combat fatigue began to accelerate in response to the many veterans suffering from chronic psychologic problems that resulted in social and occupational dysfunction (IOM, 2008a). Stemming from the World War I definition of shell shock, other common diagnoses of soldiers during World War II included exhaustion, battle exhaustion, flying syndrome, war neurosis, cardiac neurosis, and psychoneurosis (Jones, 2006). What is now known as delayed-onset PTSD was termed old-sergeant syndrome during the era of the world wars, when after prolonged combat, experienced soldiers were no longer able to cope with the constant threats of death or serious injury (Shephard, 2000). Symptoms of shell shock included tremors, tics, fatigue, memory loss, difficulty in sleeping, nightmares, and poor concentration-similar to many of the symptoms associated with PTSD. ![]() For much of the 20th century, psychologic conditions and impairments in military personnel were not accorded high medical priority because of the high fatality rates from disease, infection, and accidental injuries during war.ĭuring World War I, shell shock and disordered action of the heart were commonly diagnosed in combat veterans (Jones, 2006). Heart,” “soldier’s heart,” and “cardiac muscular exhaustion.” Many medical professionals and surgeons at the time believed that those conditions arose from the heavy packs that soldiers carried, insufficient time for new recruits to acclimatize to the military lifestyle, homesickness, and, as one army surgeon stated, poorly motivated soldiers who had unrealistic expectations of war (Jones, 2006). Others had diagnoses of exhaustion, effort syndrome, or heart conditions variously called “irritable Many Civil War soldiers had diagnoses of nostalgia or melancholia, characterized by lethargy, withdrawal, and “excessive emotionality” (Birmes et al., 2003). Prior to the codifying of PTSD by the American Psychiatric Association (APA) as a distinct mental health disorder in 1980 (APA, 1980), characteristic symptoms of PTSD had been recognized and documented in the 19th century in civilians involved in catastrophic events, such as railway collisions, and in American soldiers fighting in the Civil War (Birmes et al., 2003 Jones, 2006 Welke, 2001). The chapter concludes with special epidemiologic considerations regarding PTSD in military populations and their implications for screening, diagnosis, and treatment. Although other traumatic events-such as the terrorist attacks of September 11, 2001, and Hurricane Katrina-have increased knowledge about PTSD, this chapter does not focus on civilian populations or nonmilitary related trauma. The remainder of the chapter presents factors associated with trauma and PTSD, first in the general population and then in military and veteran populations, with an emphasis on combat as the traumatic event that triggered the development of PTSD. It begins with a brief history of the disorder in the American military, which is followed by a discussion of its diagnostic criteria. This chapter provides an overview of the epidemiology of posttrau-matic stress disorder (PTSD). History, Diagnostic Criteria, and Epidemiology
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