**9. Conclusion**

Events that are threatening to life or bodily integrity will produce traumatic stress in its victim. This is a normal, adaptive response of the mind and body to protect the individual by preparing him to respond to the the threat by fighting or fleeing. If the fight or flight is successful, the traumatic stress will usually be released or dissipated allowing the victim to return to a normal level of functioning. PTSD develops: when fight or flight is not possible;

Post Traumatic Stress Disorder – An Overview 21

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the threat persists over a long period of time; and/or the threat is so extreme that the instinctive response of the victim is to freeze. There is a mistaken assumption that anyone experiencing a traumatic event will have PTSD. This is far from true. Studies vary, but confirm that only a fraction of those facing trauma will develop PTSD (Elliott 1997, Kulka et al 1990, Breslau et al 1991). What distinguishes those who do not is still a hot topic of discussion, but there are many clues. Factors mediating traumatic stress appear to include: preparation for expected stress (when possible), successful fight or flight responses, prior experience, internal resources, support from family, community, and social networks, debriefing, emotional release, and psychotherapy.

Severe trauma during childhood can have a devastating effect on the development of the brain and all functions mediated by this complex organ - emotional, cognitive, behavioural and physiological. Intense emotional reactions in the face of these events are expected and normal, and the range of feelings experienced may be quite broad. Every conflict forces one to live through some terrible experiences. Indeed, millions of people have been present at events far beyond the worst nightmares. Trauma researchers believe that it is the repression of memories and feelings that is at the heart of trauma suffering in both the short and long term. Time does not heal trauma. Every culture has its own way of dealing with traumatic experiences. And much also depends on the family circumstances, as well as on their age and the nature of their exposure to traumatic events. In all cultures, one of the most important factors is the cohesion of the family and community, and the degree of nurture and support that one receives through events in which they had defied death.

Identification of a portion of those suffering from PTSD will be straightforward. But others may be difficult to spot owing to complicated life or defensive systems. Evaluation of the state of the autonomic nervous system will assist in the diagnosis of PTSD and in setting treatment objectives where appropriate. Preexisting negative appraisals, impaired retrieval of autobiographical memories, and decrements in verbal memory may represent trait-like cognitive phenomena that denote greater vulnerability to PTSD following trauma and predict symptom course. These areas of research have tremendous potential for contributing to prevention and treatment of PTSD, as would additional research examining relationships between cognitive phenomena that may shed light on underlying mechanisms. In addition, future research delineating cognitive difficulties in PTSD in the absence of comorbid depression would further elucidate factors contributing to and resulting from different posttraumatic sequelae. Regarding cognitive phenomena specific to trauma memories, current research examining PTSD-related intrusions provides further evidence that they are not qualitatively distinct from other intrusive cognitions.

#### **10. References**


the threat persists over a long period of time; and/or the threat is so extreme that the instinctive response of the victim is to freeze. There is a mistaken assumption that anyone experiencing a traumatic event will have PTSD. This is far from true. Studies vary, but confirm that only a fraction of those facing trauma will develop PTSD (Elliott 1997, Kulka et al 1990, Breslau et al 1991). What distinguishes those who do not is still a hot topic of discussion, but there are many clues. Factors mediating traumatic stress appear to include: preparation for expected stress (when possible), successful fight or flight responses, prior experience, internal resources, support from family, community, and social networks,

Severe trauma during childhood can have a devastating effect on the development of the brain and all functions mediated by this complex organ - emotional, cognitive, behavioural and physiological. Intense emotional reactions in the face of these events are expected and normal, and the range of feelings experienced may be quite broad. Every conflict forces one to live through some terrible experiences. Indeed, millions of people have been present at events far beyond the worst nightmares. Trauma researchers believe that it is the repression of memories and feelings that is at the heart of trauma suffering in both the short and long term. Time does not heal trauma. Every culture has its own way of dealing with traumatic experiences. And much also depends on the family circumstances, as well as on their age and the nature of their exposure to traumatic events. In all cultures, one of the most important factors is the cohesion of the family and community, and the degree of nurture

Identification of a portion of those suffering from PTSD will be straightforward. But others may be difficult to spot owing to complicated life or defensive systems. Evaluation of the state of the autonomic nervous system will assist in the diagnosis of PTSD and in setting treatment objectives where appropriate. Preexisting negative appraisals, impaired retrieval of autobiographical memories, and decrements in verbal memory may represent trait-like cognitive phenomena that denote greater vulnerability to PTSD following trauma and predict symptom course. These areas of research have tremendous potential for contributing to prevention and treatment of PTSD, as would additional research examining relationships between cognitive phenomena that may shed light on underlying mechanisms. In addition, future research delineating cognitive difficulties in PTSD in the absence of comorbid depression would further elucidate factors contributing to and resulting from different posttraumatic sequelae. Regarding cognitive phenomena specific to trauma memories, current research examining PTSD-related intrusions provides further evidence that they are

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**2** 

*USA* 

*University of Houston,* 

**Combat Related Posttraumatic** 

**Stress Disorder – History, Prevalence,** 

**Etiology, Treatment, and Comorbidity** 

Jenny A. Bannister, James J. Mahoney III and Tam K. Dao

This chapter seeks to provide a better understanding of combat related posttraumatic stress disorder. Some of the information presented in this chapter may apply broadly to all populations affected by posttraumatic stress disorder, but should not be used as a primary reference for the disorder as a whole. This chapter will first provide a brief history of the diagnosis and discuss the current diagnostic criteria including potential changes that have been suggested for the Diagnostic Statistical Manual – V. Next, the chapter will present the prevalence of posttraumatic stress disorder and explain potential gender differences in soldiers affected by the disorder. Theories of how an individual obtains posttraumatic stress disorder will be discussed and current and novel treatments will be explained. A brief discussion on traumatic brain injury will also be presented, as it is a common comorbidity of

Posttraumatic stress disorder was not officially recognized as psychological disorder until the Diagnostic Statistical Manual -III, which was published in 1980 (American Psychiatric Association, 1980; Lasiuk & Hegadoren, 2006). Posttraumatic stress disorder was known by an array of different labels previous to 1980, such as combat neurosis, railway spine, shell shock, soldier's heart, and stress response syndrome. Although it has been speculated that posttraumatic stress disorder has existed in all trauma stricken populations throughout history,the occurrence has been documented primarily in soldiers who experienced combat related trauma. (Jones et. al., 2003; Lasiuk & Hegadoren, 2006). One exception to this pattern is the historical concept of hysteria. Hysteria has also received much attention, but the symptoms associated with this term have evolved throughout history and therefore the term can only be loosely associated with posttraumatic stress disorder. This chapter will make reference to numerous historical figures that noted the similarities of hysteria to the symptoms that they

Another non-military population who exhibited posttraumatic stress disorder-like symptoms is seen in the documentation of a phenomenon called *railway spine*. This is the

**1. Introduction** 

combat related posttraumatic stress disorder.

**2. History of posttraumatic stress disorder** 

**2.1 Railway spine, soldiers' heart, and hysteria** 

were observing, but it must be noted that this concept is loosely defined.

