3/21/2024 0 Comments Apa dsm 5 criteria for ptsdThe “stress reaction” was first identified as a psychiatric diagnosis by the Veterans Administration after World War II. At about the same time, the acute and chronic physiological effect s of mental and situtional stress were elucidated (Selye, 1956). Similar symptoms consistent with stressor-induced disorders were experienced by 20th century concentration camp survivors (Frankl, 1959). That accident and the protracted period of investigation and litigation that followed led to the enunciation of “compensation neurosis” and “railway spine” as pejorative explanations for post-traumatic symptoms (Trimble, 1985). Charles Dickens was in the famous Staplehurst railway disaster in 1865, spent hours tending the grievously wounded and dying and was “not quite right within…an effect of the railway shaking” thereafter. The English diarist Samuel Pepys was incapacitated after the Great Fire of London in 1666, even though his home was not affected Pepys recorded inability to sleep, dreams of burning and falling houses, months of anger and discontent and later being frightened by news of a distant chimney fire. The mental sequelae of terrible events were early recognized in civilian life as well. In World War II and the Korean War, “combat neurosis” was replaced by “combat fatigue”, although rest usually did not alleviate the symptoms (Jones, 2013). ![]() ![]() Freud suggested that mental symptoms represented “combat neurosis”, caused by the conflict between a soldier’s “war ego” and “peace ego”. Enormous numbers of mental casualties resulted from World War I, and these were at first wrongly attributed to brain concussion from large-caliber artillery, hence the term “shell shock”. The American Civil War, felt by many historians to be the first “modern” war, produced an unprecedented surge of inexplicable illness and psychiatric morbidity, leading to the description of “soldier’s heart” and “neurasthenia” and to the observation that soldiers on leave often collapsed with mental illness at home even if they had been well during the fighting.The Russian Army in the Russo-Japanese War of 1905 was the first to recognize that battlefield catastrophe, of which they had plenty, could cause mental collapse. Swiss and German military physicians in the 17th Century identified two illnesses that caused combat soldiers to experience melancholy, weakness, anxiety, insomnia, palpitations and incessant thoughts of home, and termed them Sehnsucht (nostalgia) and Heimweh (homesickness). Physical breakdown and mental illness during and after war was recognized by the ancient Egyptians, and Herodotus described incapacitation by the events of war in the 5th Century BCE. ![]() ![]() The category also includes short-lived reactions to traumatic events (acute stress disorder) and adjustment disorder, a stress-response syndrome that has some features of PTSD along with elements of depression and anxiety (American Psychiatric Association, 2013). The new classification is centered upon the iconic post-traumatic stress disorder (PTSD), but also includes a subtype for young children (preschool type) and one in which experiential detachment or unreality are prominent (dissociative type). Although historically related to war, these conditions may be triggered by a variety of intensely traumatic events, and have in common persistent re-experiencing, avoidance, emotional numbing and a state of arousal after exposure to a dangerous or horrifying situation. The category of “Trauma and Stressor-related Disorders” is a new rubric for the variously-named forms of post-traumatic stress disorder, shell shock, combat neurosis and the like. DSM-5 Category: Trauma- and Stressor-Related Disorders Introduction
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