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Fact and fiction regarding trauma and PTSD
By KEVIN FRYLING
Reporter Staff Writer
A UB clinical psychologist sifted fact from fiction June 13 regarding a serious disorder that often is in the nation's headlines but had no official name until more than 20 years ago.
Gayle Beck, professor and associate chair in the Department of Psychology, College of Arts and Sciences, discussed "Understanding Trauma and PTSD: A Look Inside the Psychological World" as part of the UBThisSummer lecture series last week.
"Anyone who's turned a television or radio on in the last few years...has seen a whole lot of talk in the media about PTSD and trauma," said Beck. Yet, she pointed out, few know about trauma in its strict clinical sense—PTSD and "trauma" entered the official Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980—versus casual use of the term to refer to violent or disturbing events.
"The Vietnam War is what really brought PTSD out into the forefront," Beck said. "The earliest description of PTSD as 'post-Vietnam syndrome' was sort of an error because there was a lot of skepticism...and resistance to acknowledging there was a psychological cost to the war."
But the sheer numbers of soldiers who returned from Vietnam with symptoms of PTSD forced the issue, she explained, noting that frequent troop rotations and brutal combat conditions—which often wiped out large numbers in a unit in a single act of violence—eroded the social-support network or "sense of brotherhood" that had helped stave off the persistent effects of trauma in earlier conflicts.
Beck added that similar deployment conditions prevent soldiers in Iraq from forming into consistent units. "This current group of veterans are probably going to be something like [the Vietnam] group," she said. Other factors that herald higher rates of PTSD in Iraq include more female soldiers involved in combat—studies suggest women are more susceptible to PTSD—and more survivors of serious injuries due to advances in combat medicine and treatment.
Of course, she added, PTSD has existed as an unnamed phenomenon forever. "People have acknowledged for as long as we've been people that when bad things happen to people sometimes there's an emotional process that goes with it," Beck said. The earliest medical diagnoses that resemble PTSD were from an American heart surgeon who wrote about Civil War soldiers suffering from "irritable heart," as well as an English physician who observed a similar condition, called "railway spine," in survivors of train wrecks. Then came "soldier's heart" and "shell shocked" in World War I, and "battle fatigue" and "war neurosis" in World War II, she added.
The biggest breakthrough came in the mid-1980s, she said, when researchers started to realize combat-related PTSD was the same disorder as seen in victims of other serious events, such as rapes and violent car accidents.
"That was important in terms of kick-starting our diagnostic formulas," Beck explained, noting that symptoms of the disorder include nightmares and flashbacks, emotional numbness, restlessness or "physiological hyperarousal" and insomnia.
Yet, disturbances such as these are natural after a serious "life-changing event," she said, so symptoms must persist for more than a month to suggest a more serious problem. There also is "delayed onset" PTSD, which develops at least six months after the trigger event, but prevalence of this is rare, making up between 2 to 4 percent of all cases.
Certain "person factors" contribute to an individual's chances of developing PTSD, she said, including prior experiences of trauma, previous emotional problems, or "pre-trauma psychopathology," and gender. Studies suggest age and race have little impact on PTSD development and that marriage seems to possess a protective effect, she added.
Physicians, chiropractors, physical therapists and other professionals who encounter victims of violent events require more training to recognize the symptoms of PTSD, Beck concluded, since the average sufferer doesn't seek help for two years. "That's a long time to feel...that raft of symptoms I just described," she said, especially since experts are seeing great success with psychological treatments that do not require drugs.
"We've made some very, very remarkable gains in terms of understanding how to effectively treat PTSD," Beck said. "That's actually one of the big accomplishments in the mental health research world in the last 10 years."