PTSD has been known to exist since ancient times, albeit
under the guise of different names.
During the First World War it was referred to as "shell
shock"; as "war neurosis" during WWII; and as "combat
stress reaction" during the Vietnam War. In the 1980s
the term Post Traumatic Stress Disorder (PTSD) was introduced
- the term we still use today.
PTSD is essentially a memory filing error. It can happen when
people are exposed to an extraordinary life-threatening situation
which is perceived with intense fear, horror and helplessness.
At the time someone is being exposed to this intensely fearful
situation, their mind 'suspends' normal operations and it copes as
well as it can in order to survive. This might involve reactions
such as 'freezing to the spot' or instead the opposite 'flight
away' from the danger. Usually the individual is aware of coping in
an automated manner. Many Veterans will say later that their
'training took over' and they survived.
The mind does not lay a memory for the frightening event or
events in a normal way because it has delayed this until the danger
passes. The rule is that once the danger has passed, the mind will
try to file away the memory. This means it tries to file the facts
of what happened, the emotions associated with the trauma and the
sensations (eg: touch, taste, sound, vision, movement, and
The problem is that when the mind presents the memory for filing
it can be very distressing. The mind repeatedly and automatically
presents the memory in the form of nightmares, flashbacks and
intrusive unwanted memories. These
"re-experiencing" phenomena are the mind's way of
trying to file away the distressing memory. The re-experiencing can
be very unpleasant and distressing because of the nature of the
traumatic experience it exposes the sufferer to.
The individual also finds that his or her levels of
arousal (awareness) change. People can become
hyper-aroused and suffer intense symptoms of anxiety (both
physical: with shortness of breath and a racing heart, as well as
emotional: feeling on edge, looking out for signs of danger and
being 'on patrol' all the time or feeling panicky).
Many also feel emotionally numb and have trouble communicating
with others without feeling numb or irritable or both.
These hyper-arousal and emotional numbness symptoms become so
unpleasant that then individual then starts to
avoid anything linked to the original trauma, this
happens automatically. The person then avoids anything that causes
upset or irritation or that might represent danger occurs.
Avoidance can become the main coping mechanism in most
The more the individual avoids things, including confronting
what happened, the less likely is it that any memory processing
will occur, and the more likely it is that further attempts at
filing a memory will occur automatically. This leads to further
re-experiencing nightmares, flashbacks and intrusive memories.
These re-experiencing symptoms then lead on to further
hyper-arousal and emotional numbing, and this in turn leads on to
more avoidance and so on. This is how the symptoms clusters
perpetuate themselves in a vicious cycle which can go on for
In the majority of people, however, the three symptom clusters
(which represent the immediate psychological reaction to an
extraordinary situation) settles down. In some people it can
'stick' and become chronic. If this is the case, PTSD may be said
to be present. This theory is based in Horowitz's Information
For treatment to be successful, information processing must be
completed. This is why therapies aimed at helping the individual to
process and work through the traumatic material are extremely
PTSD therefore comprises three symptom
It should be noted that the more people try to use avoidance as
their main coping mechanism, the more likely it will be that they
isolate themselves and many become depressed.
Many also avoid unpleasant irritability and hyperarousal by
drinking alcohol. Some will use drugs, medications or other
substances to 'feel alive'; and to counteract the emotional numbing
In Veterans helped by Combat Stress the commonest co-morbid
clinical presentation of PTSD, is PTSD presenting with depression
and alcohol misuse disorders.
Find out more about the symptoms of
trauma that a patient might present with.
frequently asked questions.