PSYC 2490 Lecture Notes - Lecture 1: Tension Headache, Autonomic Nervous System, Neurosis
19 Jun 2018
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CASE #4
POSTTRAUMATIC STRESS DISORDER (PTSD) HAS A LONG MILITARY HISTORY:
Historically, in DSM-III and DSM-IV, we considered PTSD to be an anxiety disorder
because it begins with a fear-provoking situation. Avoidant behaviours, common to
anxiety disorders, are evident. The individual anxiously avoids both thoughts about the
event and situations that remind them of the event. PTSD also involves the strong
autonomic nervous system arousal that is also common to panic attacks and phobias.
Your textbook discusses PTSD as essentially an anxiety disorder in Chapter 5.
However, in ICD-10, PTSD is listed as under the category of Reaction to severe
stress, and adjustment disorders, which is distinguished from panic, phobias, and
general anxiety disorders. OCD is also listed separately from anxiety disorders
DSM-5 has altered its chapters to be more consistent with ICD-10, thus also separating
PTSD and OCD into distinct chapters. Why? Firstly, PTSD is a reaction to a severe
traumatic event, and thus it is distinguished by being a reaction to severe stress. Trauma
can either be a single event (such as severe accident or natural disaster) or a prolonged
stress (such a prolonged military tour of duty in a war zone). Secondly, PTSD has
aspects of being a dissociative disorder, reflecting a disrupted memory processing. We
will study dissociative disorders in Unit 4. Thus DSM-5 places PTSD in between the
chapters on Anxiety Disorders and Dissociative Disorders, indicating its linkage to both.
The importance in DSM-5 of where chapters are placed is a theme that we will see is
repeated when we study mood disorders (Unit 5).
Furthermore, when we study the history of PTSD in the military, we will find that it initially
resembled a somatic symptom disorder (DSM-5), also called somatoform (ICD-10); also
found in our course in Unit 4 along with dissociative disorders. Somatoform or somatic
symptom refers to an expression of emotional stress or conflict as a physical symptom.
CRITICAL POINT: HISTORY WILL TEACH US THAT PTSD CONTAINS ELEMENTS OF 3
CATEGORIES OF MENTAL DISORDERS: ANXIETY, DISSOCIATIVE, AND SOMATIC
SYMPTOM DISORDERS. THIS ILLUSTRATES THAT OUR DIAGNOSTIC CATEGORIES
ARE NOT DISTINCT, BUT OVERLAP CONSIDERABLY WITH MANY COMMON
SYMPTOMS.
HISTORY OF POSTTRAUMATIC STRESS DISORDER
Military reactions to war trauma and stress are integral to the history of the PTSD
diagnosis. Our current understanding of PTSD is in large part as a result of the problems
in the 1970s that were being experienced by Vietnam veterans. Vietnam was a difficult
experience for American soldiers and airmen as they were fighting a prolonged losing
battle in Asian jungles, constantly in danger and with many casualties. Further
complicating the experience, many at home in the USA (and in other countries such as
Canada) perceived this as illegitimate war, and there were many public protests against
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Document Summary
Posttraumatic stress disorder (ptsd) has a long military history: Historically, in dsm-iii and dsm-iv, we considered ptsd to be an anxiety disorder because it begins with a fear-provoking situation. Avoidant behaviours, common to anxiety disorders, are evident. The individual anxiously avoids both thoughts about the event and situations that remind them of the event. Ptsd also involves the strong autonomic nervous system arousal that is also common to panic attacks and phobias. Your textbook discusses ptsd as essentially an anxiety disorder in chapter 5. However, in icd-10, ptsd is listed as under the category of reaction to severe stress, and adjustment disorders, which is distinguished from panic, phobias, and general anxiety disorders. Ocd is also listed separately from anxiety disorders. Dsm-5 has altered its chapters to be more consistent with icd-10, thus also separating. Firstly, ptsd is a reaction to a severe traumatic event, and thus it is distinguished by being a reaction to severe stress.
