Transcript Traumatology 1004A Cognitive Behavioral Therapy For

Certified Clinical Trauma Professional
Capsule One – History of PTSD
Mike Dubi, Ed.D., LMHC
[email protected]
www.traumapro.net
Brief History of Traumatic Stress
Brief History of Traumatic Stress
Historical Vernacular of Traumatic Stress
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Nostalgia – Swiss military
Homesickness – German military
Estar Roto – Spanish “to be broken”
Soldier's Heart/Irritable Heart – Civil War
Shell-shocked - WWI
War Neurosis - Freud
Combat Exhaustion - WWII
Railway Spine/Compensation Neurosis
http://io9.com/5898560/from-irritable-heart-to-shellshock-how-post-traumatic-stress-became-a-disease
http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm
Brief History of Traumatic Stress
19th century Medical Professionals:
Jean Martin Charcot - symptoms of trauma (1860)
John Eric Erichsen –
railway spine (1867)
Jacob Mendes Da Costa –
soldier’s Heart (1871)
Freud & Breuer - relationship
between traumatic life events
and subsequent psychological
problems (1895)
Pierre Janet (1889)
Connection between events in the subject's past life and
present day trauma - coined the words dissociation and
subconscious. Study of the “magnetic passion” or “rapport”
between the patient and the hypnotist. Anticipated later
accounts of transference. Developed effective treatment for
PTSD in the late 1800s – hypnosis.
Brief History of Traumatic Stress
B.S. Oppenheimer (1918): Neurocirculatory Asthenia
Sir Thomas Lewis (1919): Effort Syndrome/ Soldier’s Heart
-abnormal condition characterized by chest pain, dizziness,
fatigue, palpitations, cold & moist hands and sighing
respiration. Mainly associated with soldiers in combat but
also in others experiencing unusual events. Pain mimics
angina pectoris but more closely connected
to anxiety states - occurs after rather than
during exercise.
B.S. Oppenheimer
Sir Thomas Lewis
Brief History of Traumatic Stress
Abram Kardiner (1891-1981) is credited with
describing the initial PTSD diagnostic criteria (1941):
• Persistence of startle response and irritability
• Proclivity to explosive outbursts of aggression
• Fixation on the traumatic event
• Constriction of one’s general level of
personality functioning
• Atypical dream life
Brief History of Traumatic Stress
1952: The first Diagnostic and Statistical Manual (DSM) published
by the American Psychiatric Association (APA) included Gross
Stress Reaction
1968: Not included in the DSM II
1980: PTSD initially introduced by the APA in DSM III – first
appearance of DX
1987: Revision of the PTSD diagnosis (DSM III-R)
1994: Expanded to include children (DSM IV)
2000: Updated and expanded to include familial patterns (DSM IVTR)
2013: DSM V includes changes to PTSD diagnosis
http://www.brainline.org/content/2011/01/posttraumatic-stressdisorder-a-history-and-a-critique_pageall.html
Brief History
• Arguably, PTSD is most researched diagnosis of the 21th century
• Although most people who experience a traumatic event will not
develop PTSD, it is one of the most common and recognizable
mental disorders
• As our military campaigns continue, we are increasing our
understanding of the systemic nature of the disorder through the
families and significant others of our veterans
PTSD Prevalence
• Prevalence of PTSD Among OEF/OIF Veterans Using VA
Health Care, FY2002–FY2012 is 29%
(FAS.org; CRS Report for Congress)
• PTSD rates are higher among veterans, police, firefighters,
EM personnel (DSM 5)
• Highest rates (1/3 - >1/2%) exists with survivors of rape,
military combat & captivity, ethnically or politically
motivated internment and genocide (DSM 5)
• Each one of these individuals has significant
others who are at risk for vicarious
traumatization and secondary
traumatization.
PTSD as a Contagion
• Research of Vietnam Veterans suggests that symptoms
are transmitted to family members.
• Veterans’ significant others are at risk for vicarious
traumatization and secondary traumatization.
• Danieli (2005) documents intergenerational transmission
of the symptoms of PTSD.
The Dutch Hunger Winter (1944-45)
When scientists talk about
epigenetics they are
referring to all the cases in
which the genetic code
alone isn’t enough to
describe what’s
happening—there must
be something else going
on as well
environmentally.
http://www.sciencedaily.com/releases/200
8/06/080624174849.htm
Genetic Changes In People with PTSD
Proceedings of the National Academy of Sciences
Uddin et al, 2010
• People diagnosed with PTSD have been found to have genetic
changes in their DNA, making them different from healthy people.
• Researchers found that there were dramatic differences between
the immune system genes
and brain cell growth genes of
people with PTSD and people
who do not have PTSD
http://www.pnas.org/content/early/2010/04/19/0910794107.full.pdf+html?sid=f47
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