**4. PTSD with psychiatric co-morbidity**

The majority of the research (Goenjian et al., 2000; Green, Lindy, Grace, & Leonard, 1992; Maj et al., 1989; McFarlane & Papay, 1992; Rubonis & Bickman, 1991) provides evidence of psychological sequelae that includes PTSD, major depressive episodes, sleep disorder, anxiety, and substance abuse after disasters. Furthermore, major depressive episodes and PTSD are the most common disaster-related psychiatric diagnoses and are strongly associated with one another (McFarlane & Papay, 1992; Goenjian et al., 2000; Green et al., 1992). Individuals confronted with disasters or major stressors exhibit greater psychological impairment and are more vulnerable to psychiatric diseases (Chou et al., 2005). The incidence of PTSD is higher than that of other major depressive episodes in the majority of the studies (Bromet & Dew, 1995; Chou et al., 2003; Chou et al., 2004a; Chou et al., 2004b; Chou et al., 2005; Davidson et al., 1991; Davidson 1995; Goenjian et al., 1994; Green et al., 1992; Sharan et al., 1996). In contrast to natural disasters, however, higher co-morbidity has been found with combat-related PTSD. Such co-morbidity includes drug and alcohol abuse, antisocial personality disorder, somatization disorder, and depression, and it is particularly prevalent when determined from an historical perspective (Green et al., 1992). PTSD can be triggered by a variety of traumatic events and is strongly associated with all other examined mental disorders (Brady, Killeen, Brewerton, & Lucerini, 2000; Goenjian et al., 2000;

Clinicians have recognized the juxtaposition of acute mental syndromes to traumatic events for more than 200 years. Observations of trauma-related syndromes were documented following the Civil War, and early psychoanalytic writers, including Freud, noted the

The American Psychiatric Association (APA) (1952) published the "Diagnostic and statistical manual of mental disorders, first edition, DSM-I'' and included in that edition gross stress reactions. However, the term PTSD was not included in the publications until the DSM-III in 1980 (Jones et al., 2003). It was then revised in the DSM-III-R (1987) and the DSM-IV (1994). According to the DSM-IV diagnostic criteria, PTSD has three core psychopathologies: (a) reexperience, (b) numbness and avoidance, and (c) hyper-arousal. The DSM-IV diagnostic criteria for PTSD allow clinicians to specify if the disorder is chronic, that is, the symptoms have lasted three months or more, or if the disorder exhibits delayed onset, that is, the onset of the symptoms was six months or more after the stressful event (Su, Tsai, Chou, et al., 2010). PTSD is an anxiety disorder that develops after a person has been exposed to a severe, life-threatening trauma. Its symptoms include a re-experiencing or reliving of the event, an avoidance or numbness toward the event, and/or hyper-arousal (American Psychiatric Association, 1994). Accordingly, PTSD is characterized by two special memory phenomena. The first is a facilitated memory of the traumatic event, including flashbacks and nightmares. The second is an inhibited memory involving the inability to voluntarily recall important aspects of the trauma (Hellawell & Brewin, 2002; Thomaes et al., 2009). These observations imply that emotional memory dysfunctions are key components in PTSD, and they include involuntary retrieval such as flashbacks and intrusions, exaggerated and context-independent fear, failure to integrate the trauma as a coherent episode into an

autobiographical memory, and impaired fear memory extinction (Wolf, 2008).

The majority of the research (Goenjian et al., 2000; Green, Lindy, Grace, & Leonard, 1992; Maj et al., 1989; McFarlane & Papay, 1992; Rubonis & Bickman, 1991) provides evidence of psychological sequelae that includes PTSD, major depressive episodes, sleep disorder, anxiety, and substance abuse after disasters. Furthermore, major depressive episodes and PTSD are the most common disaster-related psychiatric diagnoses and are strongly associated with one another (McFarlane & Papay, 1992; Goenjian et al., 2000; Green et al., 1992). Individuals confronted with disasters or major stressors exhibit greater psychological impairment and are more vulnerable to psychiatric diseases (Chou et al., 2005). The incidence of PTSD is higher than that of other major depressive episodes in the majority of the studies (Bromet & Dew, 1995; Chou et al., 2003; Chou et al., 2004a; Chou et al., 2004b; Chou et al., 2005; Davidson et al., 1991; Davidson 1995; Goenjian et al., 1994; Green et al., 1992; Sharan et al., 1996). In contrast to natural disasters, however, higher co-morbidity has been found with combat-related PTSD. Such co-morbidity includes drug and alcohol abuse, antisocial personality disorder, somatization disorder, and depression, and it is particularly prevalent when determined from an historical perspective (Green et al., 1992). PTSD can be triggered by a variety of traumatic events and is strongly associated with all other examined

mental disorders (Brady, Killeen, Brewerton, & Lucerini, 2000; Goenjian et al., 2000;

**4. PTSD with psychiatric co-morbidity** 

relation between neurosis and trauma (Kaplan & Sadock, 1999).

**3. The introduction of PTSD** 

Perkonigg, Kessler, Storz, Wittchen, 2000). For example, the combination of PTSD and panic and phobic disorders is an important predictor for PTSD chronicity (McFarlane & Papay, 1992; Ursano, Kao, & Fullerton, 1992). Furthermore, the rate of psychopathology is higher in post-disaster groups than in either the same groups prior to trauma or in control groups (Maj et al., 1989; Rubonis & Bickman, 1991).
