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542 CHAPTER 13 Psychological DisordersWe also noted in Chapter 5 that humans seem biologically prepared to acquirefears of certain animals or situations, such as snakes or heights, that were survivalthreats in human evolutionary history (Workman & Reader, 2008). People alsoseem to be predisposed to develop phobias toward creatures that arouse disgust, likeslugs, maggots, or cockroaches (Webb & Davey, 1993). Instinctively, it seems, manypeople find such creatures repulsive, possibly because they are associated with disease,infection, or filth. Such phobias may reflect a fear of contamination or infectionthat is also based on human evolutionary history (Cisler & others, 2007).Post-Traumatic Stress DisorderReexperiencing the TraumaKey Theme• Extreme anxiety and intrusive thoughts are symptoms of both posttraumaticstress disorder (PTSD) and obsessive–compulsive disorder (OCD).Key Questions• What is PTSD, and what causes it?• What is obsessive–compulsive disorder?• What are the most common types of obsessions and compulsions?Invisible Wounds: PTSD Among Iraqi andAfghanistan Veterans Infantry scout JesusBocanegra witnessed firsthand sufferingand death in Iraq. After returning,Bocanegra suffered from frequent flashbacks,nightmares, nervousness, and feltemotionally numb. Like Bocanegra, some300,000 veterans have been diagnosedwith PTSD or major depression (Tanielian,2008). The high rate of PTSD and suicidemay be related to unique aspects of theIraq and Afghanistan conflicts. As VeteransAffairs physician Nancy Seal observes,“The majority of military personnel experiencehigh-intensity guerrilla warfare andthe chronic threat of roadside bombs andimprovised explosive devices. Some soldiersendure multiple tours of duty, manyexperience traumatic injury, and more ofthe wounded survive than ever before”(Seal & others, 2007).Post-traumatic stress disorder (PTSD) is a long-lasting anxiety disorder that developsin response to an extreme physical or psychological trauma. Extreme traumasare events that produce intense feelings of horror and helplessness, such as a seriousphysical injury or threat of injury to yourself or to loved ones.Originally, post-traumatic stress disorder was primarily associated with direct experiencesof military combat. Veterans of military conflict in Afghanistan and Iraq,like veterans of earlier wars, have a higher prevalence of PTSD than nonveterans(Fontana & Rosenheck, 2008). However, it’s now known that PTSD can also developin survivors of other sorts of extreme traumas, such as natural disasters, physicalor sexual assault, random shooting sprees, or terrorist attacks (McNally, 2003).Rescue workers, relief workers, and emergency service personnel can also developPTSD symptoms (Eriksson & others, 2001). Simply witnessing the injury or deathof others can be sufficiently traumatic for PTSD to occur.In any given year, it’s estimated that more than 5 million American adults experiencePTSD. There is also a significant gender difference—more than twice as manywomen as men experience PTSD after exposure to trauma (Olff & others, 2007).Children can also experience the symptoms of PTSD (Kaplow & others, 2006).Three core symptoms characterize post-traumatic stress disorder (DSM-IV-TR, 2000). First, the person frequently recalls the event, replaying it in hermind. Such recollections are often intrusive, meaning that they are unwantedand interfere with normal thoughts. Second, the person avoids stimuli or situationsthat tend to trigger memories of the experience and undergoes a generalnumbing of emotional responsiveness. Third, the person experiences the increasedphysical arousal associated with anxiety. He may be easily startled, experiencesleep disturbances, have problems concentrating and remembering,and be prone to irritability or angry outbursts (North & others, 2009).Post-traumatic stress disorder is somewhat unusual in that the source of thedisorder is the traumatic event itself, rather than a cause that lies within the individual.Even well-adjusted and psychologically healthy people may developPTSD when exposed to an extremely traumatic event (Ozer & others, 2003).Terrorist attacks, because of their suddenness and intensity, are particularlylikely to produce post-traumatic stress disorder in survivors, rescue