May 2012 Bar Bulletin
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May 2012 Bar Bulletin

PTSD: Causes, Symptoms and Treatment

By Richard H. Adler and Arthur D. Leritz

 

Post-Traumatic Stress Disorder (PTSD) is a diagnosis frequently made for patients who have survived a serious traumatic event, but it is also a diagnosis that is greatly misunderstood.

PTSD has most recently been brought to the forefront of the world stage with the tragedy in Afghanistan involving the shooting of 17 unarmed civilians, allegedly by a soldier with PTSD.1 While PTSD has been commonly associated with veterans returning home from combat zones, 8% of the general population in the United States is believed to have suffered from PTSD at some point in their lives.2 In comparison, 13.8% of veterans returning from Iraq and Afghanistan reportedly suffer from PTSD.3 Enlisted personnel are twice as likely to suffer from PTSD as officers.4

There is no doubt that physical trauma, whether caused by armed conflict, assaults, motor vehicle crashes, falls, burns or loss of a limb, can and often does result in significant pain and emotional traumatic injury. However, the mere presence of psychological distress related to traumatic injury does not necessarily mean the patient has PTSD, though they may have other types of post-trauma, reactive disorders.

Scientific evidence has established that PTSD is a debilitating condition of both the body and the mind. As stated by the U.S. surgeon general in his "Report on Mental Health" issued in 1999, the distinction between mental and physical health is no longer tenable in this area:

One reason the public continues to this day to emphasize the difference between mental and physical health is embedded in language. Common parlance continues to use the term "physical" to distinguish some forms of health and illness from "mental" health and illness. People continue to see mental and physical as separate functions when, in fact, mental functions (e.g., memory) are physical as well. Mental functions are carried out by the brain. Likewise, mental disorders are reflected in physical changes in the brain.5

It is now accepted in the healthcare community, based on a growing body of scientific literature, that persistent and profound changes in some of the body's physiologic systems occur in individuals with PTSD. Researchers have found evidence of damage to the physical systems associated with PTSD, such as increased sympathetic nervous system activity, alterations in stress hormone secretion, memory processing and limbic system abnormalities in brain imaging studies of traumatized patients.

For a psychological injury to rise to the level of a PTSD diagnosis, it must meet all of the specific diagnostic criteria of the DSM-IV (Diagnostic and Statistical Manual, 4th edition) published by the American Psychological Association, including the following:

  • Exposure to a traumatic event in which "the person experienced, witnessed, or was confronted with ... actual or threatened death or serious injury, or a threat to the physical integrity of self or others." The patient must also have experienced the event with "intense fear, helplessness, or horror."

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