Posttraumatic stress disorder: the intersection of epidemiology and individual psychobiological adaptation

Abstract

Purpose of review: This review is written against the backdrop of the attack of September 11 and the case in the UK where veterans of recent wars are suing the Ministry of Defence for its failure to provide ongoing treatment. These two events highlight the demand for knowledge about the risks of exposure to traumatic events and the effectiveness of interventions in the aftermath. Furthermore, posttraumatic stress disorder has now been part of psychiatric nomenclature for over 20 years and it is important to reflect on the frontiers of knowledge and to ensure that we are not entering a phase of repetitive recycling of information. Recent findings: Posttraumatic stress disorder in non-compensable settings has been found to be a major source of disability and disadvantage that demands attention in any public health policy. The ability to provide early treatment depends on defining individuals who are at risk as soon as possible after exposure. The intensity of the symptoms of dissociation about the event during the first month was more important than peri-traumatic dissociation as had been suggested by earlier research. Epidemiological research of community-based samples and event-specific traumas remain the backbone of investigating the risk factors such as sex in the onset of the disorder. Few advances have occurred in the domain of treatment. The apparent benefits of atypical antipsychotics present an interesting development in the literature. Summary: The evidence demonstrates the predictable morbidity of exposure to traumatic events. The challenge is to implement systems of care that address the evidence that falls outside some of the more conventional constructs of psychiatric morbidity.