PTSD:Diagnosis & evaluation

Background
Psychological distress after trauma was reported in 1900 BCE by an Egyptian physician who described hysterical reactions to trauma (Veith 1965). Hysteria was also related to "traumatic reminiscences" a century ago (Janet 1901). At that time, Sigmund Freud's pupil, Kardiner, was the first to describe what later became known as post-traumatic stress disorder symptoms (Lamprecht & Sack 2002).

Hippocrates utilized a homeostasis theory to explain illness, and stress is often defined as the reaction to a situation that threatens the balance or homeostasis of a system (Antonovsky 1981). The situation causing the stress reaction is defined as the "stressor", but the stress reaction, and not the stressor is what jeopardizes the homeostasis (Aardal-Eriksson 2002). Post-traumatic stress can thus be seen as a chemical imbalance of neurotransmitters, according to stress theory.

However, PTSD per se is a relatively recent diagnosis in psychiatric nosology, first appearing in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. It is said development of the PTSD concept partly has socio-economic and political implications (Mezey & Robbins 2001). War veterans are the most publicly-recognised victims of PTSD: long-term psychiatric illness was formally observed in World War 1 veterans but did not appear to enter the public consciousness until the aftermath of the Vietnam War. However, victims had difficulties receiving economic compensation since there was no psychiatric diagnosis available by which veterans could claim indemnity.

This situation has changed during the last two decades, and PTSD is now one of several psychiatric diagnoses for which a veteran can receive compensation, such as a war veteran indemnity pension, in the US (Mezey & Robbins 2001). However this practice is under review in the United States. In 2005, the US Department of Veterans Affairs Veterans Benefits Administration began a review of claims after it noted a reported 30% increase in PTSD claims in recent years. Because of the negative affect on the budget and the apparent inconsistency in the rate of rewards by different rating offices of the Department, they undertook this review. There was broad political backlash from veterans rights groups and some highly publicized suicides by veterans who feared loss of their benefits (which served often as their only source of income). In response to these events, on November 10, 2005, the Secretary of the US Department 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..."

However the feeling of reprieve experienced by some veterans and veteran advocates was short-lived. Soon thereafter, the Department of Veterans Affairs announced that it had contracted with the Institute of Medicine (IOM) to conduct a[nother] study on Post-Traumatic Stress Disorder (PTSD). The Committee will review and comment on the objective measures used in the diagnosis of PTSD and known risk factors for the development of PTSD. The committee will also "review the utility and objectiveness of the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and will comment on the validity of current screening instruments and their predictive capacity for accurate diagnoses." The committee will also "review the literature on various treatment modalities (including pharmacotherapy and psychotherapy) and treatment goals for individuals with PTSD [and] ... comment on the prognosis of individuals diagnosed with PTSD and existing comorbidities." Some veteran advocates expressed concern that this was merely a backdoor method of reducing benefits to veterans who have served and currently service in Iraq and the Persian Gulf. On the other hand, conservative groups such as psychiatrist Sally Satel, who is affiliated with the conservative American Enterprise Institute, say "an underground network advises veterans where to go for the best chance of being declared disabled." The institute organized a recent meeting to discuss PTSD among veterans. Read more on the politics of PTSD at

In sum, the diagnosis is highly controversial because of the strong connection with compensation seeking behavior and efforts and the uncertainty about the affect of this on objective diagnosis of those who may have been subjected to trauma. See recent article at

While PTSD-like symptoms were recognized in combat veterans following many historical conflicts, the modern understanding of the condition dates to the 1980s. Reported OEF/OIF cases of combat-PTSD incidents are currently being compiled in ePluribus Media's PTSD Timeline: