August 1, 2012

Bruce Dow bloggingCombat-related emotional stress has been called soldier’s heart, shell shock, battle fatigue, and since the early 1970’s, posttraumatic stress disorder (PTSD).  Posttraumatic stress (PTS) is often said to be unique among currently defined mental illnesses in that it must be caused by an outside force, typically a person/persons or a force of nature.  In that sense, PTS might be considered an injury.  Like other injuries, it requires time to heal.  The time required varies with the severity of the injury, and can sometimes last a lifetime, especially in the absence of effective treatment.

Military combatants seem to prefer the notion of an injury from combat rather than a disorder, i.e., PTSI (posttraumatic stress injury) rather than PTSD.  Moreover, because of the widespread use of roadside explosive devices in the Iraq and Afghanistan Wars, returning veterans of these wars may also have a traumatic brain injury (TBI).  Some Iraq and/or Afghanistan veterans may then be suffering from two types of brain injuries, a physical injury, TBI, and a psychological injury, PTSI, or (possibly) just TSI.  Is the “P” in PTSI really necessary?  Probably yes, since stress injuries often have delayed onset.

Is anything lost by giving up the term PTSD?  Many psychiatric conditions are called disorders.  Examples include bipolar disorder, major depressive disorder, schizoaffective disorder, panic disorder, obsessive compulsive disorder, personality disorder.  According to current psychiatric practice (DSM-IV-TR), PTSD can be added to any of these other disorders, and later removed following recovery from the trauma.

Outside agents, namely parents, may contribute to the development of personality disorders, and there are many culturally-specific psychiatric disorders (anorexia nervosa, for example), so PTSD is not strictly the only disorder requiring an outside force.  Interestingly, schizophrenia is not called a disorder; it seems to be considered more of a disease, like hypertension or cancer.

Some “disorders” such as bipolar disorder and schizoaffective disorder are thought to last a lifetime, while other disorders such as major depressive disorder, panic disorder, and obsessive compulsive disorder are thought to be more treatable, even to the point of a cure, with the proper combination of psychotherapy and medication.

The present writer has seen many instances of patients recovering essentially completely from quite severe PTSD, though remaining susceptible to triggers that bring back memories of the trauma.  Examples can be found on the author’s website,

There are reasonable arguments to be made for PTSI (posttraumatic stress injury), especially in the military, and there are reasonable arguments to be made for PTSD (posttraumatic stress disorder), especially within the psychiatric community.  Considering both sides, this writer favors a change to “injury”, since it reduces stigma and may encourage more people, both military and civilian, to seek treatment.