A Brief Nosological History of PTSD

The modern conceptualization of what we now call posttraumatic stress disorder (PTSD) originated with the European neurologists Jean-Martin Charcot and Hermann Oppenheim, who treated victims of railroad and industrial accidents in the late nineteenth century. Both Charcot and Oppenheim regarded the disorder as stemming from an acute fright or emotional shock. Charcot used the term “traumatic hysteria” to describe a condition of the mind that occurred in mentally defective individuals and stemmed not from the physical effects of the traumatic accident but rather from the idea his patients had formed of it. Oppenheim rejected the hysterical nature of the condition but rather considered that the acute emotional shock induced by the traumatic event injured the nervous system. Both DSM-I and DSM-II failed to recognize these earlier insights, and they did not dignify the condition with a diagnosis. The introduction of the PTSD diagnosis into DSMIII represented a breakthrough in that it a) recognized a common syndrome or pathway shared by victims of disparate traumatic events, b) formulated specific criteria for its diagnosis, c) did not imply a pre-existing mental defect, and d) did not regard the condition as necessarily temporary. By introducing the requirement that the traumatic event induce an acute response of “intense fear, helplessness, or horror,” DSM-IV re-introduced Charcot’s and Oppenheim’s original insight into the causal role of acute emotional shock, but this requirement has now been dropped from DSM-5.