1. Post Traumatic Stress Disorder: Historical Perspective John S Price, Ph.D. Psychological Services San Antonio Police Department

2. Combat Related Stress Injuries Old problem but a new name Old problem but a new name Greek and Roman References Greek and Roman References 17 th Century through US Civil War 17 th Century through US Civil War Nostalgia Nostalgia Soldier’ Heart Soldier’ Heart

3. Combat Related Stress Injuries World War I: Shell Shock World War I: Shell Shock World War II: Combat Exhaustion or Battle Fatigue World War II: Combat Exhaustion or Battle Fatigue 1973 Israelis: Battle Shock 1973 Israelis: Battle Shock Combat Stress Reaction Combat Stress Reaction

4. Combat Related Stress Injuries DSM I: Hysteria DSM I: Hysteria DSM II: Hysteria DSM II: Hysteria DSM III: Acute Stress Disorder DSM III: Acute Stress Disorder Post Traumatic Stress Disorder Post Traumatic Stress Disorder DSM IV: Acute Stress Disorder DSM IV: Acute Stress Disorder Post Traumatic Stress Disorder Post Traumatic Stress Disorder

5. PTSD ***A psychiatric disorder that can occur following the experience/witnessing of life threatening events such as: ***A psychiatric disorder that can occur following the experience/witnessing of life threatening events such as: Military Combat Military Combat Natural Disasters Natural Disasters Terrorist Incidents Terrorist Incidents Serious Accidents Serious Accidents Violent Personal Assaults: Such as Rape Violent Personal Assaults: Such as Rape

6. PTSD Can Include Can Include Nightmares Nightmares Flashbacks Flashbacks Difficulty Sleeping Difficulty Sleeping Feeling Detached or Estranged Feeling Detached or Estranged Can Impair Daily Life Can Impair Daily Life

7. PTSD Occurs in Conjunction with Other Disorders Occurs in Conjunction with Other Disorders Such As: Such As: Depression Depression Substance Abuse Substance Abuse Problems with Cognition Problems with Cognition Physical or Mental Health Issues Physical or Mental Health Issues Can Impair Ability to Function in Social or Family Life Can Impair Ability to Function in Social or Family Life

8. PTSD Estimated 7.8 % will experience PTSD at some point in their lives Estimated 7.8 % will experience PTSD at some point in their lives Women (10.4%) twice as likely as men (5%) Women (10.4%) twice as likely as men (5%) About 3.6% of US Adults aged 18-54 (5.2 million) have PTSD during the course of a given year About 3.6% of US Adults aged 18-54 (5.2 million) have PTSD during the course of a given year 60.7% of men and 51.2% of women reported at least one traumatic event 60.7% of men and 51.2% of women reported at least one traumatic event

9. PTSD Events Most Associated with PTSD Events Most Associated with PTSD Women Women Rape Rape Sexual Molestation Sexual Molestation Physical Attack Physical Attack Threatened with a Weapon Threatened with a Weapon Childhood Physical Abuse Childhood Physical Abuse Men Men Rape Rape Combat Exposure Combat Exposure Childhood Neglect Childhood Neglect Childhood Physical Abuse Childhood Physical Abuse

10. PTSD In a 2005 VA study of 168,528 veterans, 20% were diagnosed with psychological disorders, including 1,641 with PTSD In a 2005 VA study of 168,528 veterans, 20% were diagnosed with psychological disorders, including 1,641 with PTSD The Marines and Army were nearly 4x more likely to report PTSD than Navy or Air Force because of their greater exposure to combat situations The Marines and Army were nearly 4x more likely to report PTSD than Navy or Air Force because of their greater exposure to combat situations Enlisted men were twice as likely as officers to report PTSD Enlisted men were twice as likely as officers to report PTSD

11. Combat Related Stress Injuries World War I World War I Shell Shock Shell Shock Nerveshock Nerveshock Nerveshock Crisis Nerveshock Crisis September 21, 1916 The German Association for Psychiatry convened a special “War Congress” September 21, 1916 The German Association for Psychiatry convened a special “War Congress”

12. Combat Related Stress Injuries After briefly discussing the evidence the “War Congress”, settled the debate by voting that persistent distress or functional impairment following exposure to a traumatic event could only in an individual with Hysteria After briefly discussing the evidence the “War Congress”, settled the debate by voting that persistent distress or functional impairment following exposure to a traumatic event could only in an individual with Hysteria

13. Combat Related Stress injuries 1980 DSM III PTSD replaces Hysteria 1980 DSM III PTSD replaces Hysteria Normalization model: PTSD is seen as a normal reaction to an abnormal situation Normalization model: PTSD is seen as a normal reaction to an abnormal situation

14. Combat Related Stress injuries Stress Injuries as physical damage to the brain Stress Injuries as physical damage to the brain Implications of returning to a Medical Model of stress injuries Implications of returning to a Medical Model of stress injuries

15. Combat Related Stress Injuries Questions Questions Lori and I have been looking forward to attending the Pick-up Party; unfortunately we are having problems with car. We have a friend who also joined The Flock. If she is able to give a ride we will make the party otherwise we will have to wait until next week to pick up our wine John S Price