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Post-traumatic stress disorder is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Written accounts of similar symptoms to PTSD date back to ancient times. Clear documentation started to show up in historical medical literature of the Civil War, when a PTSD-like disorder was known as Da Costa's Syndrome. There were also particularly good descriptions of post traumatic stress symptoms in the medical literature on combat veterans of World War II and Holocaust survivors. Starting with the Civil War and Da Costa's Syndrome, PTSD has taken on a couple of different names such as shell shock in World War I, and combat neurosis in World War II and the Koran War. It wasn't until after Vietnam that research and documentation began in earnest.

The American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders classification in 1980. The significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual rather than an inherent individual weakness. The key to understanding the scientific basis and clinical expression of PTSD is the concept of trauma. The framers of the original PTSD diagnosis had in mind events such as war, rape, torture, and natural disasters which are different then the very painful stressors of normal life such as failure, divorce, rejection, serious illness, and financial reverses. It is on this idea that they assumed most individuals have the ability to cope with ordinary stress but that their adaptive capabilities are likely to be overwhelmed when confronted by a traumatic stressor.

We now recognize that there are individual differences regarding the capacity to cope with stress. While some people exposed to traumatic events do not develop PTSD, others go on to develop the full blown syndrome. Trauma is analogous to pain in the sense that it isn't an external phenomenon that can be completely objectified, it is first filtered though cognitive and emotional processes. Although people have different traumatic thresholds, events such as rape, torture, genocide, and sever war zone stress are experienced as traumatic events by nearly everyone. The traumatic events most often associated with PTSD for men are rape, combat, childhood neglect, and childhood physical abuse while the events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse. Some of the factors that play into the development of PSD include severity of the traumatic event, length of the event, previous history of depression and other emotional disorders, previous history of physical and/or sexual abuse, family history of anxiety, alcohol abuse, and drug abuse.

PTSD occurs in about 8% of the American population with about 5% and 10% prevalence rates in American men and women respectively. The rates of PTSD are much higher in post-conflict settings such as Algeria, Cambodia, Ethiopia, and Gaza.

The DSM-IV criteria for diagnosing PTSD include a history of exposure to a traumatic event and symptoms form each of the three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper arousal symptoms. The symptoms of the intrusive recollection symptom cluster include recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions, recurrent distressing dreams of the event, acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated), intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, and physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. The symptoms of the avoidant/numbing symptom cluster include efforts to avoid thoughts, feelings, or conversations associated with the trauma, efforts to avoid activities, places, or people that arouse recollections of the trauma, inability to recall an important aspect of the trauma, markedly diminished interest or participation in significant activities, feeling of detachment or estrangement from others, restricted range of affect (e.g., unable to have loving feelings), and a sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span). The symptoms of the hyperarousal symptom cluster include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hyper vigilance, and exaggerated startle response. The other two criterions are if the duration of the symptoms occurs for more than one month and if the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The two most known causes of PTSD are that of a small hippocampus and a decrease in the body's cortisol level. The amygdala in people with PTSD may hyper-arouse, and be insufficiently controlled by the medial prefrontal cortex and the hippocampus. This correlates with the findings of a smaller hippocampus in PTSD patients, the function of the hippocampus may be compromised by its abnormal size. The amygdala is associated with fear conditioning; consequently, hyper-arousal or abnormal activities of the amygdala may impair the patient's emotional responses, which can be expressed as PTSD as a result of traumatic experiences. Most PTSD patients present with low secretions of cortisol coupled with catecholamine secretions that are high, producing a increased norepinephrine/cortisol ratio. Brain catecholamine levels are low, and corticotrophin-releasing factor (CRF) concentrations are high and there is increased sensitivity of the



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