Posttraumatic stress disorder: conceptualization and treatment

After a long history of both scientific and political debate, the notion that extreme psychological traumatic experiences, in and of themselves, could result in a severe, even malignant, psychiatric disorder is now established. In 1980 posttraumatic stress disorder finally became an officially classified anxiety disorder. Since then, the few controlled treatment outcome studies that have been carried out appear to indicate that the most effective treatment for PTSD is some form of exposure therapy. This is not surprising in light of the fact that several other types of anxiety disorders respond well to this form of behavioral treatment. However, PTSD may be more complex than the other types of anxiety disorders, especially with regard to the variety of symptoms involved. In its chronic form or in combat-related PTSD, no one type of treatment tested so far has been successful in reducing all the symptoms of the disorder. Psychophysiological overarousal to imaginal facsimiles of the traumatic event is especially difficult to influence with treatment. Identifying techniques that reduce or at least control this arousal will likely be grist for the research mill for many years. Theoretical and conceptual formulations regarding both the etiology and treatment of the disorder are in early stages of development. It is hoped that these efforts will eventually mature our understanding of the disorder as researchers explore important issues such as (1) predisposing factors; (2) how the nature and intensity of the stressor relates to the severity of the disorder; and (3) how biological, psychological, social, and cultural variables interact to result in PTSD and to either ameliorate or exacerbate its symptoms.