1. Certified Clinical Trauma Professional Capsule One – History of PTSD Certified Clinical Trauma Professional Capsule One – History of PTSD Mike Dubi, Ed.D., LMHC mdubi@comcast.net www.traumapro.net

2. Brief History of Traumatic Stress

3. Brief History of Traumatic Stress Historical Vernacular of Traumatic Stress Nostalgia – Swiss military Homesickness – German military Estar Roto – Spanish “to be broken” Soldier's Heart/Irritable Heart – Civil War Shell-shocked - WWI War Neurosis - Freud Combat Exhaustion - WWII Railway Spine/Compensation Neurosis http://io9.com/5898560/from-irritable-heart-to-shellshock-how-post-traumatic-stress-became-a-disease http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm

4. Brief History of Traumatic Stress 19 th century Medical Professionals: Jean Martin Charcot - symptoms of trauma (1860) John Eric Erichsen – railway spine (1867) Jacob Mendes Da Costa – soldier’s Heart (1871) Freud & Breuer - relationship between traumatic life events and subsequent psychological problems (1895)

5. Pierre Janet (1889) Connection between events in the subject's past life and present day trauma - coined the words dissociation and subconscious. Study of the “magnetic passion” or “rapport” between the patient and the hypnotist. Anticipated later accounts of transference. Developed effective treatment for PTSD in the late 1800s – hypnosis.

6. Brief History of Traumatic Stress B.S. Oppenheimer (1918): Neurocirculatory Asthenia Sir Thomas Lewis (1919): Effort Syndrome/ Soldier’s Heart -abnormal condition characterized by chest pain, dizziness, fatigue, palpitations, cold & moist hands and sighing respiration. Mainly associated with soldiers in combat but also in others experiencing unusual events. Pain mimics angina pectoris but more closely connected to anxiety states - occurs after rather than during exercise. B.S. Oppenheimer Sir Thomas Lewis

7. Brief History of Traumatic Stress Abram Kardiner (1891-1981) is credited with describing the initial PTSD diagnostic criteria (1941): Persistence of startle response and irritability Proclivity to explosive outbursts of aggression Fixation on the traumatic event Constriction of one’s general level of personality functioning Atypical dream life

8. Brief History of Traumatic Stress 1952: The first Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association (APA) included Gross Stress Reaction 1968: Not included in the DSM II 1968: Not included in the DSM II 1980: PTSD initially introduced by the APA in DSM III – first appearance of DX 1980: PTSD initially introduced by the APA in DSM III – first appearance of DX 1987: Revision of the PTSD diagnosis (DSM III-R) 1987: Revision of the PTSD diagnosis (DSM III-R) 1994: Expanded to include children (DSM IV) 1994: Expanded to include children (DSM IV) 2000: Updated and expanded to include familial patterns (DSM IV- TR) 2000: Updated and expanded to include familial patterns (DSM IV- TR) 2013: DSM V includes changes to PTSD diagnosis 2013: DSM V includes changes to PTSD diagnosis http://www.brainline.org/content/2011/01/posttraumatic-stress- disorder-a-history-and-a-critique_pageall.html

9. Brief History Arguably, PTSD is most researched diagnosis of the 21th century Arguably, PTSD is most researched diagnosis of the 21th century Although most people who experience a traumatic event will not develop PTSD, it is one of the most common and recognizable mental disorders Although most people who experience a traumatic event will not develop PTSD, it is one of the most common and recognizable mental disorders As our military campaigns continue, we are increasing our understanding of the systemic nature of the disorder through the families and significant others of our veterans As our military campaigns continue, we are increasing our understanding of the systemic nature of the disorder through the families and significant others of our veterans

10. PTSD Prevalence Prevalence of PTSD Among OEF/OIF Veterans Using VA Health Care, FY2002–FY2012 is 29% (FAS.org; CRS Report for Congress) PTSD rates are higher among veterans, police, firefighters, EM personnel (DSM 5) Highest rates (1/3 - >1/2%) exists with survivors of rape, military combat & captivity, ethnically or politically motivated internment and genocide (DSM 5) Each one of these individuals has significant others who are at risk for vicarious traumatization and secondary traumatization.

11. PTSD as a Contagion Research of Vietnam Veterans suggests that symptoms are transmitted to family members. Veterans’ significant others are at risk for vicarious traumatization and secondary traumatization. Danieli (2005) documents intergenerational transmission of the symptoms of PTSD.

12. The Dutch Hunger Winter (1944-45) When scientists talk about epigenetics they are referring to all the cases in which the genetic code alone isn’t enough to describe what’s happening—there must be something else going on as well environmentally. http://www.sciencedaily.com/releases/200 8/06/080624174849.htm

13. Genetic Changes In People with PTSD Proceedings of the National Academy of Sciences Uddin et al, 2010 People diagnosed with PTSD have been found to have genetic changes in their DNA, making them different from healthy people. Researchers found that there were dramatic differences between the immune system genes and brain cell growth genes of people with PTSD and people who do not have PTSD http://www.pnas.org/content/early/2010/04/19/0910794107.full.pdf+html?sid=f47 edbaa-6c98-4b3b-a336-b3e6bdf54aa9