ABSTRACT
Shell shock, battle fatigue, combat neurosis (Tomb, 1994), and battered wives’ syndrome are well-known lay descriptors of negative emotional responses to trauma. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM’, American Psychiatric Association, 1952) categorized such reactions as gross stress reaction, and the DSM—II (APA, 1968) used the term transient situational disturbance (Tomb, 1994). The DSM—III (APA, 1980) was the first to refer to these symptoms as posttraumatic stress disorder (PTSD), and required that the traumatic event be an experience “outside the range of usual human experience” (p. 236). However, recent research on posttraumatic stress reactions resulted in several changes in the conceptualization of PTSD in the DSM—IV (APA, 1994; Kilpatrick, Saunders, Veronen, Best, & Von, 1987; Breslau, Davis, Andreski, & Peterson, 1991; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993b). First, the definition of a stressor thought to cause negative reactions was altered. Instead of requiring an unusual or rare experience, the DSM—IV now requires that the initial stressor include (a) confrontation with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and (b) a response involving intense fear, helplessness, or horror. The definition also includes a caveat for children that allows for reactions involving disorganized or agitated behavior. Such definitional changes have several important implications for the diagnosis. Specifically, the DSM—IV (APA, 1994) allows for inclusion of nonrare experiences (e.g., severe reactions to minor traumas) as well as indirect experiences of trauma (e.g., a child witnessing parental violence). Furthermore, this new definition places greater emphasis on an individual’s perception of threat at the time of the trauma.
