Traumatic stress in the 21st century

Objective: The introduction to a series of articles on traumatic stress aim s to examine the ambivalent relationship between traumatic stress and psych iatry. It provides an outline to the very significant contribution that thi s field made before the conceptualisation of posttraumatic stress disorder (PTSD) and how the research and theoretical thinking in this field can prov ide many insights into the relationship between environmental factors and p sychological health. It focuses on the relevance of this field to general p sychiatry. Result: Posttraumatic stress disorder has emerged as the most common anxiet y disorder in women. As well, there are high rates discovered in a range of chronically ill psychiatric patient populations. In particular, strategies for dealing with the issues of childhood abuse and neglect are not often c onsidered by adult psychiatric services for the chronically and severely me ntally ill, despite there being important predictors of suicidal behaviour, hospitalisation and prolonged disability. An effective consideration of th e available evidence is often complicated by concerns about the impact of f inancial compensation on the presentation of psychopathology. This is a com plex social dialectic whose impact is important to the practise of psychiat ry. Equally, this field in itself must avoid becoming excessively rigid in its clinical definitions and the particular interventions which are espouse d. Conclusions: The impact of traumatic events on long-term psychological adju stment and physical health have been under estimated. Identification of tho se at risk is an important issue given that effective treatments are now av ailable. This is an area in which further conceptual thinking is required. It also provides particular opportunities to explore the biological process es of, and interaction between, the environment and the underlying genetic and neurobiological processes which are critical to the modulation of psych opathology.