Vol 2 n° 1 - Posttraumatic Stress Disorder
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The  role  of  psychological  trauma  (eg,  rape,  physical assaults, torture, motor vehicle accidents) as an etiologi- cal factor in mental disorders, anticipated as early as the 19th century by Janet, Freud, and Breuer, and more specifically during World War I and II by Kardiner, was “rediscovered” some 20 years ago in the wake of the psy- chological traumas inflicted by the Vietnam war and the discussion “in the open” of sexual abuse and rape by the women's liberation movement. 1980 marked a major turning point, with the incorporation of the diagnostic construct of posttraumatic stress disorder (PTSD) into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the definition of its main diagnostic  criteria  (reexperiencing  of  the  traumatic event, avoidance of stimuli associated with the trauma, and symptoms of increased arousal). Initially described as resulting from a onetime severe traumatic incident, PTSD has now been shown to be triggered by chronic multiple traumas as well. This “state-of-the-art” article discusses past and current understanding of the disorder, with par- ticular emphasis on the recent explosive developments in neuroimaging and other fields of the neurosciences that have highlighted the complex interrelationships between the psychological, psychiatric, biological, and neuro- anatomical components of the disorder, and opened up entirely new therapeutic perspectives on how to help the victims of trauma overcome their past. he human response to psychological trauma is one of the most important public health problems in the world. Traumatic events such as family and social vio- lence, rapes and assaults, disasters, wars, accidents and predatory violence confront people with such horror and threat that it may temporarily or permanently alter their capacity to cope, their biological threat perception, and their concepts of themselves. Traumatized individuals frequently develop posttraumatic stress disorder (PTSD), a disorder in which the memory of the traumatic event comes to dominate the victims’ consciousness, depleting their lives of meaning and pleasure.1 Trauma does not only  affect  psychological  functioning:  for  example,  a study  of  almost  10  000  patients  in  a  medical  setting2 reported that persons with histories of severe child mal- treatment showed a 4 to 12 times greater risk for devel- oping alcoholism, depression, drug abuse, and suicide attempts, a 2 to 4 times greater risk for smoking, ³50 sex partners, and sexually transmitted disease, a 1.4 to 1.6 times greater risk for physical inactivity and obesity, and a 1.6 to 2.9 times greater risk for ischemic heart disease, cancer, chronic lung disease, skeletal fractures, hepatitis, stroke, diabetes, and liver disease. Prevalence Traumatic events are very common in most societies, though prevalence has been best studied in industrial- ized societies, particularly in the USA. Kessler et al3 Posttraumatic stress disorder and the nature of trauma Bessel van der Kolk, MD Keywords: posttraumatic stress disorder; stress; history of medicine; dissociation; premorbid personality; neuroimaging; DESNOS (disorders of extreme stress not otherwise specified); hippocampus; amygdala; neurohormone; SSRI (selective serotonin reuptake inhibitor); emotional processing; EMDR (eye movement desensitization and reprocessing)

Author affiliations: Professor of Psychiatry, Boston University School of Medicine, Boston, Mass, USA AddressAddress for correspondence: Prof Bessel van der Kolk, Trauma Center, 227 Babcock Street, Brookline, MA 02446, USA
(e-mail: bvanderk@traumacenter.org) T 7 S t a t e   o f   t h e   a r t