Harvard Mental Health Letter

Rethinking posttraumatic stress disorder

What is a traumatic event, and how does it produce symptoms?

"It could go on for years and years, and has, for centuries," wrote the author of the Sumerian epic of Gilgamesh in the third millennium, B.C., describing the suffering of a character who survived a violent encounter that killed his friend. That terrifying experiences often have lasting psychological consequences was well known for thousands of years before 1980, when the American Psychiatric Association classified posttraumatic stress disorder (PTSD) as a psychiatric disorder in the third edition of its diagnostic manual (DSM-III). PTSD is one of the few psychiatric conditions to which the manual ascribes a definite cause. Although no one doubts that emotional trauma can have devastating effects, a debate about this diagnosis has been ignited, and changes may be in store.

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