Post-traumatic Stress Disorder: The End of a Journey or the Start of a New One?

Marissa Yetter is currently a second year student at Grinnell College. She intends to declare a major in Psychology with a concentration in Neuroscience. She chose this topic to research based on an interest in PTSD and the current research being done to find new and better treatments. She also developed a general interest throughout the course in the development of psychiatry as a legitimate medical field.

On February 6th, 2013, The New York Times published an article by James Dao about a team of researchers in the psychiatry department at NYU who have recently begun a five-year study with the hopes to find biomarkers (concrete biological signals) that are linked to the existence of PTSD. These markers would provide a more concrete and definite diagnosis for PTSD or post traumatic stress disorder, and could eliminate the number of PTSD cases that go undiagnosed or are wrongly diagnosed.  It has been estimated that over the past decade, half a million war veterans have been diagnosed with post-traumatic stress disorder (PTSD) or a traumatic brain injury [1]. But how many of these diagnoses missed something or were wrong? We have no way of knowing if this number, already shockingly large, should be higher or lower. It is clear however, that PTSD is a significant problem in our society today, inflicting thousands of soldiers returning from war. It is fascinating that what stands in our way now is finding the presence of physical markers to ensure the effects felt by a patient are indeed caused by PTSD when it once was not even recognized as a legitimate mental disorder. Could this biological research be the final step in the long and drawn out development of PTSD over nearly two centuries?

Evidence of psychological war trauma began to surface back in the era of the American Civil war in the 1860’s. The Civil war was one of the first instances that drew attention to lasting emotional and mental trauma as well as physical trauma. Many soldiers’ reactions to the horrors of combat were simply brushed aside as was cowardice or malingering, but it soon became clear that these emotional tolls had a more lasting effect on men, plaguing them even after their service was over and making it difficult to readjust to their normal lives [2]. Shell shock and hysteria became the more commonly used terms for these lasting psychological effects in World War I, which was the next major instance of combat trauma seen by the U.S. [3]. In the later years of the American involvement of World War I however, psychiatrists began to take more of an interest in the classification of these symptoms, labeling it as traumatic neurosis, and by the end of the war, military psychology had become its own field of medicine, marking an important step in the rise and recognition of PTSD [4].

By the end of the second World War and the beginning of the Vietnam war, the criteria and understanding of PTSD as its own disorder had at long last been established and put into use. Once again, the need for this push forward was driven by the amount of war trauma seen in these two major conflicts. The medical progress that came out of World War II in terms of diagnosing and treating PTSD was accompanied by social changes that led to a wider understanding and acceptance of the condition. This enabled veterans to take a stand for the first time and lobby the government for care and compensation for psychological injuries as a result of serving in the war [5]. Perhaps at the peak of this political and social change surrounding psychological war trauma, came the inclusion of the PTSD in the newest version of the DSM, which is still the most widely used and accredited diagnostic tool in American psychiatric practice today. A full list of symptoms and criteria for diagnosis were published in the DSM-III in 1980, becoming the final step in solidifying the disorder as a legitimate and treatable condition. Many would argue that the story of PTSD ends here. But what of the potential for new findings on biological markers for PTSD?

Research has shown that veterans with PTSD have decreased activity in the frontal cortex of the brain which is associated with memory deficits. This contributes to loss of ability to extinguish or inhibit conditioned fear-responses. This makes it hard to let go of the fearful memories acquired in combat [6]. Genetic studies have also identified a gene that has been linked to predisposition to PTSD, making some more susceptible than others to the disorder. The military can now use this gene as a marker for which soldiers are higher risk for psychological combat trauma [7]. These findings are also being used to modify and improve treatment methods for PTSD.

There is still much room for error and overlap in a DSM diagnosis, and it may be the case that many of our diagnoses are still inaccurate or lacking in some way, leading to the mistreatment of a disorder. There has been a lot of recent discussion stemming from the concern that we are now over-diagnosing PTSD. It is estimated that nearly thirty percent of soldiers returning home from Afghanistan and Iraq are being treated with PTSD, a rate that has increased significantly [8]. Perhaps the discovery of biological indicators that can aid in the diagnosis of PTSD is the only way to determine if this is an accurate figure or not, ending the medical journey of the development of PTSD. Or perhaps this biological research is the start of a whole new journey. It is yet unknown.

_____________________________

  1. James Dao, “Study Seeks Biomarkers for Invisible War Scars,” The New York Times, February 6, 2013.
  2. John Talbott, “Combat Trauma in the American Civil War.” History Today 46.3 (1996): 41-47. Print.
  3. Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War. New York: Palgrave, 2002. Print.
  4. R. Levandoski, The medical discourse on military psychiatry and the psychological trauma of war: World war I to DSM-III thesis].University of North Carolina at Chapel Hill, 2010.95 Pp., 95. Retrieved from http://search.proquest.com/docview/742952963?accountid=7379. (742952963;         92797).
  5. G. C. Lasiuk and K. M. Hegadoren. “Posttraumatic Stress Disorder Part II: Development of the Construct Within the North American Psychiatric Taxonomy.” Perspectives In Psychiatric Care 42.2 (2006): 72-81.
  6. Society for Neuroscience. “Biomarker For PTSD And Why PTSD Is So Difficult To Treat.”ScienceDaily, 11 Nov. 2007. Web. 6 Dec. 2013.
  7. Elaine Schmidt, “UCLA Study Identifies Genes Linked to Post-traumatic Stress Disorder.” UCLA Newsroom (2012).
  8. Jamie Reno, “The Hero Project,” The Daily Beast, October 10, 2013.
Advertisements

Comments Off on Post-traumatic Stress Disorder: The End of a Journey or the Start of a New One?

Filed under Uncategorized

Comments are closed.