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POSTTRAUMATICSTRESS

DISORDER(PTSD)

This entry briefly examines the history of the diagno-

sis of PTSD, the current symptoms that characterize

this syndrome, risk factors for PTSD, and evidence

about the prevalence of this disorder in relation to spe-

cific traumas. It also summarizes the debate about the

expression of PTSD in children and other special pop-

ulations and discusses the ongoing controversies sur-

rounding this diagnosis. A special effort is made to

include mention of forensic issues relevant to the

diagnosis of PTSD.

History of the PTSD Diagnosis

PTSD was officially introduced into the mental health

nomenclature in 1980 with the publication of the

American Psychiatric Association’s Diagnostic and

Statistical Manual, third edition (DSM-III). The con-

cept of a cluster of symptoms that occur in response to

a particular stressor, however, has existed for centuries

and has been referred to by terms such as nerve-

trauma hypothesis, shell shock, andstress response

syndrome. In DSM-I, veterans of World War II and the

Korean War who continued to experience traumatic

symptoms were diagnosed as having gross stress

reactions.By DSM-II, in 1968, this term was replaced

withtransient adjustment disorder of adult life.The

actual addition of the diagnosis of PTSD to the DSM-III

has been attributed to the political and social pressure

applied by advocates and psychiatrists after the

Vietnam War; although these individuals more specif-

ically lobbied for the inclusion of a DSMdiagnosis of

post-Vietnam syndrome.However, the DSM-IIITask

Force argued against including a diagnosis that was

tied to a specific political event, while they were

simultaneously persuaded by data showing that simi-

lar stress reactions occurred in victims exposed to

other traumatic stressors, including natural disasters,

rape, and/or confinement in a concentration camp.

The DSM-III Task Force thus decided that an individ-

ual suffering from PTSD must have been exposed to a

traumatic event, including but not necessarily restricted

to combat, that was outside the realm of ordinary

experience to meet the criteria for PTSD. Conse-

quently, PTSD and the recently included diagnosis of

acute stress disorder are distinctive in the DSMsystem

because, unlike the majority of DSMdiagnoses, the

causal origin of these disorders is explicitly delineated

in the diagnostic criteria.

Current PTSD Diagnostic Criteria

The research related to the disorder was greatly inten-

sified after the inclusion of PTSD in the official

nomenclature of DSM-III, was instrumental in the

development of a variety of assessment tools geared

toward measuring trauma symptoms, and led to the

development of scholarly journals devoted to the topic

of trauma. These events, in turn, provided much of the

information to be considered by the task forces dedi-

cated to creating the DSM-III-R, which was published

in 1987; the DSM-IV, which was published in 1994;

and the DSM-IV-TR, which was published in 2000.

Considerable changes to the diagnostic criteria for

PTSD were introduced in these revisions. One striking

difference was in the nature of the trauma that had to

be experienced to receive this diagnosis. The trauma

criteria in DSM-IV-TRnow specify that the affected

person had to experience, witness, or be confronted

with an event(s) that involved actual or threatened death,

serious injury, or a threat to the physical integrity of

self or others. The person also had to experience

intense fear, helplessness, and/or horror in response to

the traumatic event or events.

These changes have considerably broadened the

types of events that can be considered as precipitants

to PTSD since the traumatic event did not have to be

directly experienced by the individual with PTSD

symptoms or be highly unusual or statistically infre-

quent. Consequently, PTSD has now been claimed to

result after a variety of events, including a difficult

labor (even with a healthy baby), a miscarriage, watch-

ing a traumatic event on TV, the shock of receiving

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