Posttraumatic Stress Disorder (PTSD)
- LAST REVIEWED: 26 February 2020
- LAST MODIFIED: 26 February 2020
- DOI: 10.1093/obo/9780199828340-0094
- LAST REVIEWED: 26 February 2020
- LAST MODIFIED: 26 February 2020
- DOI: 10.1093/obo/9780199828340-0094
Introduction
Severe reactions to experiences such as combat and railway accidents have been described since the mid-19th century by numerous physicians, including Sigmund Freud and Pierre Janet. These descriptions include two types of characteristic symptoms: dissociative symptoms, in which there is a general disturbance in normal mental functions, such as memory, consciousness, time estimation, sense of reality, and identity, and reexperiencing symptoms, in which the traumatic event is vividly relived as though it were happening all over again in the present. Despite this early recognition, posttraumatic stress disorder (PTSD) was formally defined only in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-III (Washington, DC: American Psychiatric Association, 1980). Prior to this, exposure to stress was assumed to produce only short-term problems in adjustment. In the DSM-III, PTSD required exposure to “a recognizable stressor that would evoke significant symptoms of distress in almost everyone” (p. 238) and was “outside the range of normal human experience” (p. 236). In addition four symptoms had to be present reflecting reexperiencing of the traumatic event, numbing and detachment, and a more pervasive change in arousal or emotions. The introduction of the disorder in the DSM-III was strongly influenced by studies of combat veterans and women in violent relationships, which suggested the existence of more long-lasting psychiatric conditions, variously termed “combat neurosis,” “rape trauma syndrome,” or “battered women syndrome.” The PTSD diagnosis was designed to subsume these syndromes and capture what was considered to be an essentially normal response to any overwhelming trauma. This made it unlike other psychiatric disorders, which all implied some vulnerability on the part of the person who succumbed to it. The definition was refined in the Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R published in 1987, which introduced more symptoms and required at least one reexperiencing symptom (e.g., intrusive memories or nightmares), three avoidance or numbing symptoms (e.g., avoidance of reminders of the traumatic event or loss of interest in activities), and two hyperarousal symptoms (e.g., exaggerated startle or irritability). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, introduced in 1994, retained a similar structure. The 2013 Diagnostic and Statistical Manual of Mental Disorders: DSM-5 increased the number of symptoms from seventeen to twenty and reorganized them into four symptom clusters, reexperiencing, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. In 1992 PTSD also appeared in another major international classification system, the tenth edition of the World Health Organization’s International Classification of Diseases (ICD-10) (Geneva, Switzerland: World Health Organization, 1992–1994). This formulation placed more emphasis on “episodes of repeated reliving of the trauma in intrusive memories (‘flashbacks’) or dreams” and also identified avoidance, numbing, and hyperarousal as central features. International Classification of Diseases (ICD-11) (Geneva, Switzerland: World Health Organization, 2019) greatly simplified the PTSD diagnosis, requiring one out of two reexperiencing symptoms, one out of two avoidance symptoms, and one out of two sense of threat symptoms, along with impairment in functioning.
Introductory Works
The history of the recognition of posttraumatic reactions starting in the 19th century is described in a number of publications (Weisaeth 2014, Wilson 1994). One of the most influential 20th-century theorists has been the psychiatrist Mardi J. Horowitz, whose work Horowitz 2011 on general reactions to stressors such as bereavement played a major role in the original formulation of PTSD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-III (Washington, DC: American Psychiatric Association, 1980). As of the early 21st century, PTSD and its close relative, acute stress disorder, remain the only psychiatric disorders to specify a causal agent, and PTSD continues to be a controversial diagnosis. The main criticisms are that the disorder was introduced for political rather than scientific reasons, that it inappropriately medicalizes normal human reactions, that it gives too much weight to the stressful event and not enough to the person, that it is not distinct from other recognized disorders, and that its symptom structure is too complex (Brewin 2003; Rosen and Lilienfeld 2008; Spitzer, et al. 2007; Young 1995).
Brewin, Chris R. 2003. Posttraumatic stress disorder: Malady or myth? New Haven, CT: Yale Univ. Press.
Text written for a general audience that reviews the historical and scientific controversies over PTSD and related issues, such as recovered memories of trauma. Presents an evidence-based update of current knowledge.
Horowitz, Mardi J. 2011. Stress response syndromes: PTSD, grief, adjustment, and dissociative disorders. 5th ed. Plymouth, UK: Jason Aronson.
A landmark text putting forward an information-processing model of response to stress involving the interplay of involuntary thoughts and images and the attempts made to avoid them. The first edition, published in 1976, had a major influence on shaping the phenomenology of PTSD in the DSM-III.
Rosen, Gerald M., and Scott O. Lilienfeld. 2008. Posttraumatic stress disorder: An empirical evaluation of core assumptions. Clinical Psychology Review 28.5: 837–868.
DOI: 10.1016/j.cpr.2007.12.002
The authors dispute the premise that a distinct class of traumatic events is linked to a distinct clinical syndrome, the core assumption that ostensibly distinguishes the PTSD diagnosis from virtually all other psychiatric disorders. They conclude that virtually all core assumptions and hypothesized mechanisms of PTSD lack compelling empirical support. Available online for purchase or by subscription.
Spitzer, Robert L., Michael B. First, and Jerome C. Wakefield. 2007. Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders 21.2: 233–241.
DOI: 10.1016/j.janxdis.2006.09.006
The authors review evidence that fails to support some of the key assumptions behind the PTSD diagnosis and propose more stringent definitions of a traumatic event and of posttraumatic symptoms. Available online for purchase or by subscription.
Weisaeth, Lars. 2014. The history of psychic trauma. In Handbook of PTSD: Science in practice. 2d ed. Edited by Matthew J. Friedman, Terence M. Keane, and Patricia A. Resick, 38–59. New York: Guilford Press.
Provides an overview of the origins of the clinical and scientific study of traumatic stress from the 19th century to the early 21st century.
Wilson, John P. 1994. The historical evolution of PTSD diagnostic criteria: From Freud to DSM-IV. Journal of Traumatic Stress 7.4: 681–698.
Reviews Sigmund Freud’s descriptions of reactions to trauma and traces these through the development of the various editions of the American Psychiatric Association’s Diagnostic and Statistical Manual. Available online for purchase or by subscription.
Young, Allan. 1995. The harmony of illusions: Inventing post-traumatic stress disorder. Princeton, NJ: Princeton Univ. Press.
Argues that PTSD is not a timeless or universal phenomenon newly discovered; rather, it is a cultural product gradually put together by the practices, technologies, and narratives with which it is diagnosed, studied, and treated by the various interests, institutions, and moral arguments mobilizing these efforts.
Users without a subscription are not able to see the full content on this page. Please subscribe or login.
How to Subscribe
Oxford Bibliographies Online is available by subscription and perpetual access to institutions. For more information or to contact an Oxford Sales Representative click here.
Article
- Abnormal Psychology
- Academic Assessment
- Acculturation and Health
- Action Regulation Theory
- Action Research
- Addictive Behavior
- Adolescence
- Adoption, Social, Psychological, and Evolutionary Perspect...
- Adulthood
- Advanced Theory of Mind
- Affective Forecasting
- Affirmative Action
- Ageism
- Ageism at Work
- Aggression
- Allport, Gordon
- Alzheimer’s Disease
- Ambulatory Assessment in Behavioral Science
- Analysis of Covariance (ANCOVA)
- Anger
- Animal Behavior
- Animal Learning
- Anxiety Disorders
- Art and Aesthetics, Psychology of
- Artificial Intelligence, Machine Learning, and Psychology
- Assessment and Clinical Applications of Individual Differe...
- Attachment in Social and Emotional Development across the ...
- Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults
- Attention-Deficit/Hyperactivity Disorder (ADHD) in Childre...
- Attitudes
- Attitudinal Ambivalence
- Attraction in Close Relationships
- Attribution Theory
- Authoritarian Personality
- Autism
- Bayesian Statistical Methods in Psychology
- Behavior Therapy, Rational Emotive
- Behavioral Economics
- Behavioral Genetics
- Belief Perseverance
- Bereavement and Grief
- Biological Psychology
- Birth Order
- Body Image in Men and Women
- Burnout
- Bystander Effect
- Categorical Data Analysis in Psychology
- Childhood and Adolescence, Peer Victimization and Bullying...
- Clark, Mamie Phipps
- Clinical Neuropsychology
- Clinical Psychology
- Cognitive Consistency Theories
- Cognitive Dissonance Theory
- Cognitive Neuroscience
- Communication, Nonverbal Cues and
- Comparative Psychology
- Competence to Stand Trial: Restoration Services
- Competency to Stand Trial
- Computational Psychology
- Conflict Management in the Workplace
- Conformity, Compliance, and Obedience
- Consciousness
- Coping Processes
- Correspondence Analysis in Psychology
- Counseling Psychology
- Courage
- Creativity
- Creativity at Work
- Critical Thinking
- Cross-Cultural Psychology
- Cultural Psychology
- Daily Life, Research Methods for Studying
- Data Science Methods for Psychology
- Data Sharing in Psychology
- Death and Dying
- Deceiving and Detecting Deceit
- Defensive Processes
- DEI in Organizations
- Depression
- Depressive Disorders
- Development, Prenatal
- Developmental Psychology (Cognitive)
- Developmental Psychology (Social)
- Diagnostic and Statistical Manual of Mental Disorders (DSM...
- Discrimination
- Disgust
- Dissociative Disorders
- Drugs and Behavior
- Eating Disorders
- Ecological Psychology
- Ecopsychology
- Educational Settings, Assessment of Thinking in
- Effect Size
- Embodiment and Embodied Cognition
- Emerging Adulthood
- Emotion
- Emotional Intelligence
- Empathy and Altruism
- Employee Stress and Well-Being
- Environmental Neuroscience and Environmental Psychology
- Ethics in Psychological Practice
- Event Perception
- Evolutionary Psychology
- Expansive Posture
- Experimental Existential Psychology
- Exploratory Data Analysis
- Eyewitness Testimony
- Eysenck, Hans
- Factor Analysis
- Festinger, Leon
- Five-Factor Model of Personality
- Flynn Effect, The
- Forensic Psychology
- Forgiveness
- Friendships, Children's
- Fundamental Attribution Error/Correspondence Bias
- Gambler's Fallacy
- Game Theory and Psychology
- Geropsychology, Clinical
- Global Mental Health
- Habit Formation and Behavior Change
- Happiness
- Health Psychology
- Health Psychology Research and Practice, Measurement in
- Heider, Fritz
- Heuristics and Biases
- History of Psychology
- Human Factors
- Humanistic Psychology
- Humor
- Hypnosis
- Implicit Association Test (IAT)
- Industrial and Organizational Psychology
- Inferential Statistics in Psychology
- Insanity Defense, The
- Intelligence
- Intelligence, Crystallized and Fluid
- Intercultural Psychology
- Intergroup Conflict
- International Classification of Diseases and Related Healt...
- International Psychology
- Interviewing in Forensic Settings
- Intimate Partner Violence, Psychological Perspectives on
- Introversion–Extraversion
- Item Response Theory
- Kurtosis
- Language
- Laughter
- Law, Psychology and
- Lazarus, Richard
- Leadership
- Learned Helplessness
- Learning Theory
- Learning versus Performance
- LGBTQ+ Romantic Relationships
- Lie Detection in a Forensic Context
- Life-Span Development
- Lineups
- Locus of Control
- Loneliness and Health
- Mathematical Psychology
- Meaning in Life
- Mechanisms and Processes of Peer Contagion
- Media Violence, Psychological Perspectives on
- Mediation Analysis
- Meditation
- Memories, Autobiographical
- Memories, Flashbulb
- Memories, Repressed and Recovered
- Memory, False
- Memory, Human
- Memory, Implicit versus Explicit
- Memory in Educational Settings
- Memory, Semantic
- Meta-Analysis
- Metacognition
- Metamemory
- Metaphor, Psychological Perspectives on
- Microaggressions
- Military Psychology
- Mindfulness
- Mindfulness and Education
- Minnesota Multiphasic Personality Inventory (MMPI)
- Money, Psychology of
- Moral Conviction
- Moral Development
- Moral Psychology
- Moral Reasoning
- Motivation
- Music
- Narcissism
- Narrative
- Nature versus Nurture Debate in Psychology
- Neuroscience of Associative Learning
- Nonergodicity in Psychology and Neuroscience
- Nonparametric Statistical Analysis in Psychology
- Observational (Non-Randomized) Studies
- Obsessive-Complusive Disorder (OCD)
- Occupational Health Psychology
- Older Workers
- Olfaction, Human
- Operant Conditioning
- Optimism and Pessimism
- Organizational Justice
- Parenting Stress
- Parenting Styles
- Parents' Beliefs about Children
- Path Models
- Peace Psychology
- Perception
- Perception, Person
- Performance Appraisal
- Personality and Health
- Personality Disorders
- Personality Psychology
- Person-Centered and Experiential Psychotherapies: From Car...
- Phenomenological Psychology
- Placebo Effects in Psychology
- Play Behavior
- Positive Psychological Capital (PsyCap)
- Positive Psychology
- Posttraumatic Stress Disorder (PTSD)
- Prejudice and Stereotyping
- Pretrial Publicity
- Prisoner's Dilemma
- Problem Solving and Decision Making
- Procrastination
- Prosocial Behavior
- Prosocial Spending and Well-Being
- Protocol Analysis
- Psycholinguistics
- Psychological Literacy
- Psychological Perspectives on Food and Eating
- Psychology, Political
- Psychoneuroimmunology
- Psychophysics, Visual
- Psychotherapy
- Psychotic Disorders
- Publication Bias in Psychology
- Race
- Reasoning, Counterfactual
- Rehabilitation Psychology
- Relationships
- Reliability–Contemporary Psychometric Conceptions
- Religion, Psychology and
- Remote Work
- Replication Initiatives in Psychology
- Research Methods
- Resilience
- Risk Taking
- Role of the Expert Witness in Forensic Psychology, The
- Rumination
- Sample Size Planning for Statistical Power and Accurate Es...
- Savoring
- Schizophrenic Disorders
- School Psychology
- School Psychology, Counseling Services in
- Self, Gender and
- Self, Psychology of the
- Self-Construal
- Self-Control
- Self-Deception
- Self-Determination Theory
- Self-Efficacy
- Self-Esteem
- Self-Monitoring
- Self-Regulation in Educational Settings
- Self-Report Tests, Measures, and Inventories in Clinical P...
- Sensation Seeking
- Sex and Gender
- Sexual Minority Parenting
- Sexual Orientation
- Signal Detection Theory and its Applications
- Simpson's Paradox in Psychology
- Single People
- Single-Case Experimental Designs
- Situational Strength
- Skinner, B.F.
- Sleep and Dreaming
- Small Groups
- Social Class and Social Status
- Social Cognition
- Social Neuroscience
- Social Support
- Social Touch and Massage Therapy Research
- Somatoform Disorders
- Spatial Attention
- Sports Psychology
- Stanford Prison Experiment (SPE): Icon and Controversy
- Stereotype Threat
- Stereotypes
- Stress and Coping, Psychology of
- Student Success in College
- Subjective Wellbeing Homeostasis
- Suicide
- Taste, Psychological Perspectives on
- Teaching of Psychology
- Terror Management Theory
- Testing and Assessment
- The Concept of Validity in Psychological Assessment
- The Neuroscience of Emotion Regulation
- The Reasoned Action Approach and the Theories of Reasoned ...
- The Weapon Focus Effect in Eyewitness Memory
- Theory of Mind
- Therapy, Cognitive-Behavioral
- Thinking Skills in Educational Settings
- Time Perception
- Trait Perspective
- Trauma Psychology
- Twin Studies
- Type A Behavior Pattern (Coronary Prone Personality)
- Unconscious Processes
- Video Games and Violent Content
- Virtues and Character Strengths
- Wisdom
- Women and Science, Technology, Engineering, and Math (STEM...
- Women, Psychology of
- Work Well-Being
- Workforce Training Evaluation
- Wundt, Wilhelm