Evolution / History of PTSD in the DSM: Awareness, Research and Resources
“The DSM definition of PTSD is quite straightforward: A person is exposed to a horrendous event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” causing “intense fear, helplessness, or horror,” which results in a variety of manifestations: intrusive reexperiencing of the event (flashbacks, bad dreams, feeling as if the event were occurring), persistent and crippling avoidance (of people, places, thoughts, or feelings associated with the trauma, sometimes with amnesia for important parts of it), and increased arousal (insomnia, hypervigilance, or irritability). This description suggests a clear story line: A person is suddenly and unexpectedly devastated by an atrocious event and is never the same again. The trauma may be over, but it keeps being replayed in continually recycling memories and in a reorganized nervous system.” ― Bessel van der Kolk
History: From Shell Shock to PTSD
History of PTSD in the DSM Research
"The concept of Post-Traumatic Stress Disorder (PTSD) has evolved significantly over time. Here’s a brief overview of its history:
- Early Recognition: Symptoms resembling PTSD have been noted throughout history. Ancient texts, including works by Hippocrates, describe symptoms similar to what we now recognize as PTSD 1.
- World Wars: During World War I, the term “shell shock” was used to describe soldiers experiencing symptoms like fatigue, tremors, and nightmares. This term evolved into “combat stress reaction” during World War II 1.
- Vietnam War: The term PTSD emerged during the Vietnam War, as researchers studied the psychological effects of combat on soldiers. This period saw the term “post-Vietnam syndrome” being used 1.
- DSM Inclusion: In 1980, PTSD was officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This inclusion marked a significant shift, recognizing that PTSD was caused by external traumatic events rather than inherent individual weaknesses 2 3.
- Modern Understanding: Today, PTSD is understood to affect not only war veterans but also survivors of various traumas, including natural disasters, accidents, and personal assaults. The criteria for diagnosing PTSD have been refined over successive editions of the DSM 4 5.
- Treatment Evolution: Treatment approaches have also evolved, from early misconceptions and controversial methods to modern therapies like cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and medication 6.
The understanding and treatment of PTSD continue to advance, with ongoing research aimed at improving outcomes for those affected by this condition.
PTSD inclusion in the DSM
Post-Traumatic Stress Disorder (PTSD) has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since the DSM-III, which was published in 1980. Over the years, the criteria for diagnosing PTSD have evolved, reflecting advances in understanding and research.
DSM-III (1980)
- Introduction: PTSD was first officially recognized and included as a distinct diagnosis.
- Criteria: Focused on the traumatic event and the individual’s response, which had to involve intense fear, helplessness, or horror.
DSM-IV (1994)
- Refinement: Expanded the criteria to include a broader range of symptoms and stressors.
- Symptom Clusters: Introduced three symptom clusters: re-experiencing, avoidance/numbing, and hyperarousal.
DSM-5 (2013)
- New Category: PTSD was moved to a new category called Trauma- and Stressor-Related Disorders.
- Expanded Criteria: The criteria were expanded to include four symptom clusters: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity1.
- Additional Features: Included criteria for children under six years old and added a dissociative subtype.
DSM-5-TR (2022)
- Updates:The DSM-5-TR (Text Revision) included updates to reflect scientific advances since the DSM-5’s release but did not change the diagnostic criteria for PTSD 1 2.
Key Criteria in DSM-5-TR
- Exposure to Trauma: Directly experiencing, witnessing, learning about, or repeated exposure to traumatic events.
- Intrusion Symptoms: Unwanted memories, nightmares, flashbacks, and severe distress or physical reactions to reminders of the trauma.
- Avoidance: Efforts to avoid trauma-related thoughts, feelings, or external reminders.
- Negative Alterations in Cognition and Mood: Inability to recall aspects of the trauma, negative beliefs, distorted blame, persistent negative emotions, diminished interest in activities, and feelings of detachment.
- Alterations in Arousal and Reactivity: Irritability, reckless behavior, hypervigilance, exaggerated startle response, concentration issues, and sleep disturbances.
- Duration: Symptoms must persist for more than one month.
- Functional Impairment: Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning 1 2. (Source: Microsoft Copilot
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From Shell Shock to PTSD: Proof of War’s Traumatic History The Conversation
From Shell Shock to PTSD, a Century of Invisible War Trauma PBS News
From Shell Shock to PTSD and Traumatic Brain Injury: A Historical Perspective on Responses to Combat Trauma American Psychological Association
The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward Wiley Online Library
The PTSD History Timeline Banyan Treatment Center
The Organization of DSM-5-TR™ Updated Edition Mental Health and Motivation
Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice The Professional Counselor
The Historical Evolution of PTSD Diagnostic Criteria Springer Link
Understanding the History of PTSD Verywell Health
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History of PTSD in Veterans: Civil War to DSM-5 U.S. Department of Veterans Affairs
How Veterans Created PTSD JSTOR
PTSD History and Overview U.S. Department of Veterans Affairs
Posttraumatic Stress Disorder as a Diagnostic Entity – Clinical Perspectives Taylor and Francis Online
Redefining Posttraumatic Stress Disorder for DSM-5 ScienceDirect
History of PTSD in Veterans: Civil War to DSM-5 U.S. Department of Veterans Affairs
How Veterans Created PTSD JSTOR
PTSD History and Overview U.S. Department of Veterans Affairs
Posttraumatic Stress Disorder as a Diagnostic Entity – Clinical Perspectives Taylor and Francis Online
Redefining Posttraumatic Stress Disorder for DSM-5 ScienceDirect
Shell Shock and PTSD: A Tale of Two Diagnoses Mary C. Vance, MD, MSc; Joel D. Howell, MD, PhD PDF Download
The History of Forgetting, From Shell Shock to PTSD Listen ABC
The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward Wiley Online Library
The PTSD History Timeline Banyan Treatment Center
The Organization of DSM-5-TR™ Updated Edition Mental Health and Motivation
Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice The Professional Counselor
The Historical Evolution of PTSD Diagnostic Criteria Springer Link
Understanding the History of PTSD Verywell Health
What’s Shell Shock & Is There a Difference Between It and PTSD? Moment of Clarity
The Evolution Of Post Traumatic Stress Disorder - Video