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Posttraumatic Stress Disorder – some thoughts

03 April 2018 - Dr Jan Orman

60-70% of the Australian community will experience a traumatic event at some time in their lives. These are events that have the potential to result in some long term psychological complications. Only 20% of those people will develop symptoms of PTSD.

What we used to think about PTSD:

In Napoleonic times it was thought that the sound generated by the wind of the cannon balls that missed you was responsible for the symptoms, but during the French Revolution those exposed to horrors unrelated to cannon balls were experiencing lasting psychological problems as well. The 18th century French physician Phillipe Pinel (,  remembered for his efforts to have psychiatric patients treated more humanely, was the first to fully describe what he called “cardiorespiratory neurosis” and acute post traumatic stupor (which he called “idiotism”).

It wasn’t until the early 20th century that “combat hysteria” became “war neurosis” but it is not clear whether the change in terminology made much difference to the way the condition was perceived. In the past it was thought that those who suffered from “shell shock” or “war neurosis” were “fearful and fainthearted” (that’s from the Old Testament of the Christian Bible - Deuteronomy 20:1-9) but there are also many tales throughout history of men of great heroism on the battlefield who were still awakened at night by terrible dreams.

Much was written about war neurosis as the century moved on into WWI notably, in English, by wartime poets like Siegfried Sassoon and Wilfred Owen. These two met in the Craiglockhart War Hospital in Edinburgh where both were recovering from “shell shock”, but they had both served honourably on the western front in action that saw each of them decorated for bravery.

What we think now:

In 1980 the American Psychiatric Association finally listed PTSD as a psychiatric disorder in the 3rd edition of its Diagnostic and Statistical Manual (DSM III). It strongly stipulated that the condition was NOT due to individual weakness (neurosis) but due to traumatic events external to the sufferer, and that point is key to our current understanding. Those traumatic events are not confined to the experience of soldiers in war zones. In the 5th edition of DSM the traumatic events included death or threatened death, actual or threatened serious injury and actual or threatened sexual violence. These could have been experienced either directly or as a witness or indirectly when exposed to the details of the trauma, as happens to so many first responders and medical professionals.

What makes a particular traumatic event especially potent when it comes to causing psychological injury in those experiencing it, those witnessing it or those hearing about it?

We know that PTSD is more likely if:

  • trauma is extreme, severe and prolonged
  • trauma victims are unsupported by social and family networks after the traumatic event
  • trauma is repeated over time
  • victims are unable to talk about their symptoms and their experience
  • there is an element of betrayal (eg involving a trusted other)
  • the stressor has been interpersonal and intentional (eg torture or sexual violence)
  • There has been a moral injury (transgression of the persons values by themselves or others eg hurting civilians in a war, failing to provide medical assistance, failing to report rape)

Our webinar:

The next eMHPrac webinar on 10th April at 1.00pm and again at 8.00pm will be about managing the after effects of trauma and some online resources that may help you do this.

If you are a health or allied health practitioner you can register to attend the live webinars “First Do No Harm”. Select your preferred session below:

Afternoon session - 1pm, Tuesday 10th April 2018

Evening session - 8pm, Tuesday 10th April 2018

Dr Jan Orman
Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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