It is a challenge for future research to unravel the differences and to create order ( 6), as most research is conducted with the DSM definition while most countries in the world use instead ICD. This is a major concern for the field of traumatic stress studies. Empirical studies have found that prevalence rates may vary between the two classifications and there is often a lack of overlap (i.e., not the same individuals are classified as PTSD patients by the two classifications). The definition may be more flexible to use (allowing for cultural variation and clinical judgment) but is less detailed and comprehensive. It consists of three categories (reexperiencing, avoidance, hyperarousal) with only two core symptoms in each category. Recently a relatively different definition of PTSD has been introduced in the new version of the International Classification of Diseases of the World Health Organization (2018). The other categories are symptoms of avoidance of the reminders of the trauma (criterion C), alterations in memories or mood associated with the trauma (criterion D), and finally clear alterations in physiological arousal and reactivity. Re-experiencing the traumatic event (criterion B) is manifested in symptoms such as intrusive memories, distressing dreams, flashbacks, or distress or physiological reactions upon exposure to cues of the trauma. According to DSM-5 ( 1), PTSD consists of four categories of symptoms. The diagnosis of PTSD is directly linked to experiencing or witnessing a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent assault (criterion A). However, because of the ambivalent perspective on the Vietnam War, authorities and professionals were rather reluctant to acknowledge these difficulties, but the increasing concern led to the introduction of the term post-traumatic stress disorder in the anxiety disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) ( 5). They suffered from nightmares, depression, relationship problems, et cetera. In the 1970s, the United States became increasingly confronted with the psychological and social difficulties of the nearly three million veterans who had fought in Vietnam. That development is quite unique as the attention for trauma was very meager just 40, 50 years ago. The concept of posttraumatic stress disorder (PTSD) is nowadays so much used that it dominates most thinking about the consequences of violence, disaster, and being a refugee. Rise and Bloom of the Concept of Post-Traumatic Stress Disorder ( 4) stated, these findings make clear that it is rather normal to be exposed to a very upsetting event in one’s lifetime. The specific rates were: 14% had experienced intimate partner or sexual violence, 34.3% accidents or injuries, 22.9% physical violence, 13.1% war-related events, 34.1% the unexpected or traumatic death of a loved one, and 35.7% experienced traumas that happened to loved ones (e.g., serious illness of a child). These data showed that at some time in their life 70.4% of the respondents had experienced at least one type of a traumatic event. The World Mental Health Surveys of adults were carried out among nearly 70,000 participants from 24 countries ranging in economic status from low to high ( 4). In the words of Janoff-Bulman ( 3), basic assumptions have been shattered.Įxposure to traumatic events is not rare, as has been consistently found in epidemiological studies. The images one holds of oneself and the environment no longer adequately fit the new situation. The obvious certainties of life have disappeared. The sense of invulnerability, the idea of the benevolence of the world, and the idea that other people can be trusted are devastated. In “Jenseits des Lustprinzips” (1920), Freud already posed: “the essence of a traumatic situation is an experience of helplessness that is brought about either externally or internally.” At the same time, he or she is confronted with a shattering of basic assumptions. The individual has lost control over the situation and is to a large extent a victim of the circumstances and/or other people (i.e. Phenomenologically such an event can be characterized by an extreme sense of powerlessness as well as a disruption of beliefs and expectations. According to the psychiatric classifications, a traumatic event is defined as the exposure to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence ( 1, 2). Traumatic events involve the confrontation with war, violence, disasters, sudden loss, serious illness, and other overwhelming and disturbing events.
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