IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 175 Appendix I-
P
Appendix 1
pW~TRAUh.IAT1CSTRESS DlSOllDEll 0193-953x194 ShOU + .20
POST-TRAUMATIC STRESS
DISORDER lN THE MILITARY
VETERAN
Matthew J. Friedman, MD, PhD, Paula P. Sclinurr, PhD,
and Amimarie McDonagh-Coyle, MD
Before tire for~nalization of post-traumatic stress disorder (BrSD) as a diae
nosis in 1980, war-rclated psychiatric syndromes were known under a variety 01
names, including slrell shock, trntrnmtic ronr r~enrosis, and rnr,rbot mbnaslion. Whatever
the label, it is clear h~athese labels referred to a condition much like what
we now recognize as PTSD. For example, Kardiner and Spiegeim described a
chronic tnomatic war neurosis that involved preoccupation with the traumatic
slrsor, nightmares, irrihbility, increased startle re$ponsiveness, a tendency to
angry outbunb, and general impairment of funclioniig.
Futtemian and Purnpian-Mindlin" reported a 10% prevalence of traumatic
war neurosis in a series of 200 ~svchiatric ~atienlseen in 1950.They noted as
significant the fact that many oftl;e men had not sought treatment e;en 5 years
after the war. Follow-up studies of World War 11 veterans continunl into the
1950s, when veterans of the Korean War were included as a comparison group
in some studies, Investigators continued lo ol>serve significant symptoms in
uclernns up to 20 years postcombaL Archibald et al' found World War I1 combat
velerans with "gross shes syndrome" to have severe problems such as increased
startle, sleep disturbance, and avoidance of activities rerni~~isceat of canibat. A
follow-up of thw men !hat included Korean War veterans shorved the same
, symptom profile artd rr.lalir,ely more symptoms than in noncombat psychiatric
patients or in combat controls.'
PlSD is a Ionz-term reaction to war-zone emosure. Briefer reactions to
combat st~ss
are &own bv a varietv of names? ailhouell combat stress rencliolt
(CSRj wems lo be rite moir ca)n!mon.~~lk may bi bricl. Lst~r~g only ., fnu huurs
or rvcn a few minutes. or may persisl for sei~eal r,.w!c Solomon"dKribesst*
rymptun~ cluster;: psvclta numbtng, anx~ely rcxtions, guilt about functiunine.
Dr. McDoi~a~h-Co~le is un Ambula~oryC~SC Fellow supported by 1Iw Department of
Vctcraw. Afiairs, While RiverJunction, Vermont.
-- --
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD
T