PTSD was first added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of the third edition. The criteria for a diagnosis of PTSD consists of exposure to a traumatic event, persistent re-experiencing and intrusive recollections of that event, avoidance behaviors associated with it, increased arousal levels and difficulty sleeping or concentrating related to the trauma.
- Brief history of the DSM
- Changes in criteria for PTSD diagnosis over the years
- Research leading up to the inclusion of PTSD in the DSM
- The impact and controversy surrounding the recognition of PTSD as a mental disorder
- Current treatments available for individuals with PTSD
- Conclusion and future considerations for understanding and treating PTSD
In 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) released its third edition, changing the way people talk about mental health. The DSM-III, as it came to be known, was one of the first attempts to provide a comprehensive overview of diagnostic criteria for various psychiatric disorders. While some conditions already had an established set of diagnostic criteria prior to the release of DSM-III, there were others that needed new guidelines in order for their symptoms to be acknowledged and treated. One such condition was post traumatic stress disorder (PTSD).
The inclusion of PTSD within the DSM-III marked a turning point in history – finally recognizing psychological trauma as a legitimate illness. With this recognition also came increasing public awareness about psychological trauma and its effects on those who have experienced it directly or witnessed it occur around them. This helped shape current treatments that are used today by clinicians treating patients with PTSD and other related conditions.
Since being added to the DSM-III in 1980, subsequent editions have continued making changes based on evidence from clinical studies and patient experiences; thereby redefining how PTSD is talked about and managed today. Consequently, what was once thought to be a rare disorder has grown increasingly common due to greater acknowledgement within both scientific circles and society at large over time.
Brief history of the DSM
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the authoritative source used by mental health professionals around the world to diagnose mental illnesses. First published in 1952, it has undergone several revisions over the years as new research regarding mental health issues continues to evolve. It wasn’t until 1980 that Post Traumatic Stress Disorder (PTSD) was added to the DSM for the first time.
The initial publication of DSM-I in 1952 was focused on descriptively categorizing various forms of psychological disorders based upon observed symptoms. However, with no treatments or interventions available, much of its content included advice from psychiatrists on dealing with such conditions rather than offering medical treatment options. Subsequent editions later introduced a plethora of diagnostic categories, making certain criteria more specific so clinicians could make better diagnoses and offer better treatments for their patients.
In 1974 – two years prior to PTSD being added to the DSM-III – The American Psychiatric Association formed a Task Force specifically dedicated to reviewing stress disorder related ailments including PTSD which had been gaining greater attention among researchers at this time due largely to cases associated with Vietnam War veterans suffering from severe trauma linked symptoms after returning home from combat duty overseas. This increased awareness led to an overhaul and reclassification process where psychiatric experts evaluated case studies presented before them while also considering existing evidence-based approaches when discussing potential additions and modifications that would be included in later versions of the DSM manual through revisions such as those made between 1980 – 1987 regarding PTSD diagnosis criteria changes which have remained mostly unchanged since then.
Changes in criteria for PTSD diagnosis over the years
Since the early 1980s, when Post Traumatic Stress Disorder (PTSD) was officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), medical professionals have continually sought to refine its criteria. In an effort to better assess the severity of PTSD for diagnosis, subsequent revisions in the DSM have included detailed criteria for symptoms such as intrusive memories, re-experiencing events, avoidance behaviors, negative changes in cognition and mood and alterations in arousal or reactivity.
The fifth edition of the DSM saw some significant changes from previous iterations with respect to PTSD criteria. As well as a more thorough definition for assessing both trauma exposure and symptom intensity, DSM-5 also reduced PTSD’s subcategories from three clusters (A – intrusive memories; B – avoidant behaviors; C – hyperarousal) down to two: Intrusion/Re-experiencing Symptoms and Avoidance/Numbing & Arousal Symptoms. It also introduced complexity by adding additional requirements within each category which depend on frequency or duration of post traumatic stress symptoms.
Perhaps one of the most noteworthy additions was Criterion A2 – ‘Exposure to Actual or Threatened Death’ – which adds weight to traumatic events that may not be life threatening yet still cause extreme fear or distress experienced during or immediately following them. This criterion includes examples such as witnessing a death of another person due to violence or natural causes, being threatened with death or serious injury at gunpoint and sexual assault that may have involved physical injury caused by intense fear after a threat of serious harm from perpetrator against self or others. Taking into account these types of experiences is important when considering whether an individual’s mental health issues are indeed related directly back to trauma they endured in their past.
Research leading up to the inclusion of PTSD in the DSM
In the decades leading up to the official diagnosis of Post-traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM), clinicians around the world observed that survivors of traumatic events often experienced a variety of debilitating symptoms. Symptoms such as intrusive memories, nightmares, avoidance behaviors, hyperarousal, and flashbacks were commonly seen in those who had experienced war, disaster, or interpersonal violence. While there had been prior attempts to define disorders related to psychological trauma, it was not until 1980 when PTSD was officially recognized by DSM III with its own diagnostic criteria.
An important milestone in this journey occurred six years earlier in 1974 when renowned psychologist Judith Herman published her classic work: “Trauma and Recovery”. In her book, Herman advocated for both recognition and treatment of those suffering from psychiatric consequences of extreme stress. She urged psychiatrists to move away from what she saw as an outdated model which put primary emphasis on individual defects rather than external causes for mental illness. Her research helped pave the way towards a broader understanding of trauma as a biological phenomenon which needed more focused attention within psychiatry.
One year later in 1975 came another breakthrough: The American Psychiatric Association established an ad hoc committee entitled The Study Group on Stress and Combat-Related Syndromes which was headed by doctor Robert J. Lifton at Yale University School of Medicine. This committee undertook their mission with significant resources including funds from Veterans Administration Hospitals throughout the country. Their comprehensive survey provided additional data linking traumatic events with subsequent psychological issues among veteran populations who had served in different wars over many years – particularly Vietnam War veterans afflicted with so called “Vietnam Syndrome”. These findings were subsequently used by DSM experts during deliberations regarding addition PTSD into DSM III several years later.
The impact and controversy surrounding the recognition of PTSD as a mental disorder
In 1980, Post Traumatic Stress Disorder (PTSD) was recognized as a mental disorder by the American Psychiatric Association and included in its Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This acknowledgment has had far reaching implications both medically and socially.
For those suffering from symptoms related to trauma or traumatic events, the addition of PTSD to the DSM provided them with a diagnosis that legitimized their emotional pain. Symptoms such as intrusive thoughts, flashbacks, nightmares, emotional numbness or extreme emotional reactions have often been dismissed or minimized prior to this recognition. With an official diagnosis for PTSD available through medical professionals, there is now greater access to treatment options such as therapy and medications.
The recognition of PTSD caused controversy amongst various groups due to some perceiving it could be used in situations where psychological damage is potentially exaggerated – notably instances involving post injury lawsuits or military compensation claims. Such criticism has led to necessary adjustments being made within the fields of both medicine and law regarding documentation requirements associated with formal diagnoses of PTSD in order to ensure legal standards are met.
Current treatments available for individuals with PTSD
Psychological treatments available for those with post-traumatic stress disorder (PTSD) vary depending on the severity of symptoms and individual needs. One of the most popular forms of psychological treatment is Cognitive Behavioral Therapy (CBT). This type of therapy helps individuals reframe negative thoughts, allowing them to understand how their thoughts affect their emotions and behaviors. Through CBT, individuals may learn how to identify triggers that cause them distress or discomfort and become equipped with more positive coping strategies.
Exposure therapy is another form of treatment which encourages patients to confront memories, situations, objects or activities that may be linked to a traumatic event in an effort to reduce fear responses. Individuals can also practice mindfulness techniques such as meditation and breathing exercises which can help manage anxiety levels associated with PTSD.
Supportive psychotherapy offers an environment for individuals who have experienced trauma to safely discuss their experiences without judgement or stigma. Supportive psychotherapy helps promote resilience by teaching self-care skills such as healthy lifestyle practices and ways to better manage relationships within one’s environment. By providing access to mental health professionals trained in understanding trauma-related issues, this type of therapy assists in rebuilding trust while encouraging independence during recovery from PTSD.
Conclusion and future considerations for understanding and treating PTSD
In the medical field, Post-Traumatic Stress Disorder (PTSD) was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Since then, PTSD has become a staple disorder studied among mental health professionals and physicians alike. This life altering psychological response is often seen in those exposed to extreme stress or traumatic events.
It is estimated that as much as 8% of American adults have experienced PTSD at some point in their lives and it does not discriminate between genders or ethnic backgrounds. Symptoms include recurring nightmares, flashbacks, intrusive memories, hyperarousal and other changes in thinking or behavior. These symptoms can make everyday activities very difficult if left untreated by a mental health specialist.
Currently there are a variety of treatments aimed at aiding individuals with PTSD including but not limited to medications such as SSRIs, cognitive behavioral therapy techniques, psychotherapy sessions and even eye movement desensitization reprocessing (EMDR). Each treatment has its own unique benefits depending on the individual’s set of circumstances which should be taken into account when deciding on how best to treat an individual’s case of PTSD. With more research conducted for understanding the long term effects and causes of this disorder, treatments will continue to evolve leading us closer towards finding better ways for helping people overcome their symptoms.