A CENTURY OF CONTROVERSY SURROUNDING POSTTRAUMATIC STRESS-SPECTRUM SYNDROMES - THE IMPACT ON DSM-III AND DSM-IV

The authors describe historical clinical reports that preceded the dev elopment of criteria for posttraumatic stress disorder (PTSD) and infl uenced the formation of PTSD in DSM-IV These reports were identified f rom extensive search of 19th- and 20th-century American and European m edical literature. Relevant findings from the most representative repo rts are described and discussed. Since the mid-19th century, clinical syndromes resembling PTSD have been described However understanding of PTSD has been complicated by questions of nomenclature, etiology, and compensation Nomenclature placed PTSD syndromes under existing psychi atric disorders: traumatic hysteria, traumatic neurasthenia, or trauma tic neurosis. Etiological issues have been concerned often solely with organic factors, pre-existing personality impairments, intrapsychiatr ic conflicts, and social factors. Only after World War II and the conc entration camp experiences did the role of severe trauma in PTSD becom e recognized. Even though controversy remains, much progress in unders tanding PTSD has been made.