By Stephen M. Raffle, M.D.

(Sometimes Spelled Posttraumatic Stress Disorder)

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition originally diagnosed in soldiers. The earliest description was in the Crimean War. Since then it has had a variety of names attached to it such as shell shock (World War I) or war neurosis (World War II). It is an anxiety disorder arising as a result of an emotionally overwhelming experience. The symptom complex commonly includes nightmares that recapitulate the traumatic event, recurrent intrusive thoughts about the event, phobias (overwhelming fears) when the person is exposed to a situation reminiscent or resembling the traumatic event, and unbidden intrusive thoughts about the event.In my forensic psychiatry practice, I have observed PTSD to be common, but often erroneous diagnosis. A treating doctor may make a PTSD diagnosis merely because an individual has been exposed to a situation that might cause PTSD. There are many instances where an individual is exposed to an event that some people would find traumatic, such as being in a train wreck, only to have that particular individual not develop the persisting signs and symptoms (more than one month later) necessary for a PTSD to be diagnosed. Also, if an individual is not emotionally overwhelmed by the experience, then the subsequent appearance of a post-traumatic stress disorder is unusual.

The psychiatric expert, in my opinion, must conduct a careful psychiatric examination of the person claiming PTSD in order to determine how the traumatic experience affected him or her. Only if it can be established that the person was overwhelmed by the experience, such as a person fearing for his life or being helpless in a situation, can the necessary, but not sufficient, criteria for this condition be met.

If an individual is not exposed to an event that is inherently and potentially overwhelming, then this individual, in my opinion cannot develop PTSD. For example, if a person was frightened by a barking dog, this would not constitute a sufficient trauma for a PTSD to develop, but if the individual were bitten by the dog she might develop a PTSD. As in most things in life, the devil is in the details.

Note Regarding Post-traumatic Stress Disorder: Originally post-traumatic stress disorder type injuries were recognized in combatants in warfare. Over time, non-war-related injuries were found to cause equivalent symptoms. Just as the fact that not every soldier in combat develops Post-Traumatic Stress Disorder, not all individuals who are exposed to potentially traumatic experiences suffer PTSD. “Emotional resilience” appears to be the determining factor. This may be difficult to quantify but it appears related to the level of denial a person carries in his mind as a psychological defense against susceptibility to emotional injury. The less the pre-trauma denial, the more the resilience, or so it seems. Different emotional experiences affect individuals differentially, just as individuals exposed to the same physical challenge will experience it differently. Depending on the muscle mass, elasticity of tendons and ligaments, and bone brittleness, one person might have no injury, a second person a sprain or strain, and a third person a broken bone. The force of the trauma increases the likelihood of a broken bone or sprain and strain, but the outcome is not inevitable except under circumstances exceeding the body’s limits.

[Research reported by the New York Times, et al. on this website's News page suggests alarming increases in PTSD, Suicide and other mental health issues.  Whether the Crimean War, Vietnam War or, more recently, the Middle East (Iran, Iraq, Afghanistan, the Gulf War), Dr. Raffle, above, discusses that PTSD is found in a variety of contexts, not just as fallout from active duty in the military.  Nevertheless, click on this paragraph to review excerpts of articles on the News page. -- Beryl Vaughan, Web Editor]

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