Talk:Post-traumatic stress disorder/Archive 3

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NO HYPHENS in "Posttraumatic..." PLEASE

The DSM-IV and DSM-IV-TR do not hyphenate posttraumatic. This is (therefore) the correct page/name for this article. If anything, bringing it to lowercase would be appropriate, but no hyphens please! We've covered this before as well.

Thank you all. Have a good night/morning/day. • VigilancePrime • • • 08:54 (UTC) 17 Mar '08

Wow, I didn't mean to push a button. In your edit summary, you shouted: "PLEASE SEE THE TALK PAGE. What "most sources" state and what the official name is are two different things, and we have discussed this AD NASEUM." I note that our naming conventions call for us to use the name most commonly found in print sources, and explicitly do not call for the "official" or "most correct" name. I'm not sure there's a general consensus to ignore that naming convention in this particular case. -GTBacchus^(talk) 18:20, 17 March 2008 (UTC)

Let me first apologize for the somewhat knee-jerk reaction. We HAVE been over this before, maybe not quite ad naseum (it seems like it, but in researching back, I found less than I had thought). After the fact I was able to track links and stuff back to a "non-controversial page moves" bit and see that you were only the messenger, so to speak... I didn't mean to shoot you. ;-)

As for the name, we - those of us with expertise and who have been working on the article - had come to this consensus long before. It seems that if Wikipedia wants credibility, it needs to be accurate, and that means using the most reliable of reliable sources. In this (and other psychiatric cases), that would mean using the DSM-IV-TR as the firstmost reference. Do also note that since moving the page back, I have added reference marks to the lead paragraph which also makes the DSM literally reference #1.

As for shouting, while (apparently - feel the chagrin) caps is usually considered shouting, realize that - as far as I know - using boldface in an edit summary is not possible, so one (me) must revert to the old-school method (before we had AOL-speak and that crap)... the intent was to garner attention, as "see talk page" has historically not worked. If you were offended, please realize that was completely not the intent and become un-offended if possible.  :-D

Anyway, again, please do not take it personally as I did come to realize that you were only carrying out what you thought was an already consensused or routine series of page moves. "No harm/no foul" my old Battery Commander would tell me (though sometimes he used it in the strangest of contexts), and I'm perfectly content with your intent and comfortable with the article at this time.

Cheers, • VigilancePrime • • • 07:37 (UTC) 18 Mar '08

Thanks for your explanation, that helps. Do you think it would be fair to say that there is a consensus among those working on mental health articles to use terminology as standardized by DSM, rather than defaulting to WP:COMMONNAME? If that's the case, then we could write that down somewhere, and save the trouble later on if someone makes the same mistake I did. -GTBacchus^(talk) 18:21, 19 March 2008 (UTC)

Totally!!! (or, in an edit summary where boldface is not an option, "TOTALLY!")...

             ;-)

• VigilancePrime • • • 19:37 (UTC) 19 Mar '08

Ah, there seems to already be something in place, at Wikipedia:Manual of Style (medicine-related articles)#Naming conventions. If this comes up in the future, you can refer people to "WP:MEDMOS", and I'll remember that, too.

Actually, looking at it closely, it recommends using ICD names for diseases, and I read in our article on ICD that ICD and DSM are mostly in accord. It might be worthwhile to add to that naming convention that, for mental illnesses, we use the DSM-IV standard. Does that seem right? -GTBacchus^(talk) 22:48, 19 March 2008 (UTC)

I left a note there about possibly updating the guideline. -GTBacchus^(talk) 23:02, 19 March 2008 (UTC)

...and it didn't turn out too conclusively: see this section. -GTBacchus^(talk) 06:06, 20 March 2008 (UTC)

May I recommend, though it may seem US-centric, that perhaps the DSM should be the standard naming convention for psychiatric/psychological issues? The example of Tourette's Disorder was ideal... the "Syndrome" page can redirect to "Disorder" and no harm done, and no need to make the lengthy ICD page. No drama, simple, effective. Just a thought. • VigilancePrime • • • 06:33 (UTC) 20 Mar '08

If you wish to recommend that, go to WP:MEDMOS and do so. That seems to be the relevant guideline. -GTBacchus^(talk) 14:12, 20 March 2008 (UTC)

Hi folks. A thought: the issue of the spelling is actually kind of interesting, and the lack of the hyphen (or simply a space) sticks out like a sort thumb. I think it would be a good idea to add a short explanation to the article. Also, I don't think the non-hyphenated version is appropriate anywhere except in the title, according to my understanding of the style guidelines for medical articles (use the scientific name in the title, write for the average person in the body of the article, avoid jargon.) I've never seen the unhyphenated version anywhere else except here and in the DSM. I'd say the "common names" are PTSD, post-traumatic stress disorder, and post traumatic stress disorder. Perhaps we should start a petition to get them to put a hyphen in for DSM-V ! SeattleJoe (talk) 05:56, 24 March 2008 (UTC)

No... I agree with the above that "posttraumatic stress disorder" is correct and ought to be used, but whichever form is used, it must be consistent throughout the article. It may be confusing to some people to see "posttraumatic" if they are used to "post traumatic" or "post-traumatic," but it would be much more confusing to have one form in the title and another in the body of the article. Regardless, I think this is rendered moot by the fact that "PTSD" is used in most of the body anyways, which is both clear and an accepted acronym. Zefryl (talk) 15:19, 24 March 2008 (UTC)

Hi Zefty. That's part of the reason I suggested giving an explanation in the text. That would relieve the confusion. But I have to stick to my guns. I agree about it being a moot point, but it is used once, as the first word in the article. Whether or not someone changes it, I still think an explanation of the odd spelling is called for. It is completely counter-intuitive, and sticks out like a sore thumb. SeattleJoe (talk) 19:00, 24 March 2008 (UTC)

OK, this arrogant newbie has put his neck out and added an edit, explaining the various spellings. It is in the History/Earliest reports section, where the coining of the term is discussed, and where the hyphen already scandalously appears. This will give you folks a chance to see if my idea really sucks or not, if nothing else.

I do this in a spirit of good-will and peace among all nations, and it shall be my final contribution on this subject, no matter the fate of my sterling prose. SeattleJoe (talk) 20:01, 24 March 2008 (UTC)

While I give the ICD credit for trying, even in countries that technically use it (like Australia), the DSM is still pretty much the de facto standard. 124.169.36.244 (talk) 14:14, 30 March 2008 (UTC)

Unfortunatelly, this comment is unsourced. In my own practice, profession, and country, the DSM is indeed the standard, but the international standard is clearly the ICD, and there it's "post-traumatic...". Please see the online ICD-10, here: http://www.who.int/classifications/apps/icd/icd10online/index.htm?kf00.htm+ Beyond that, "posttraumatic stress disorder" is a professional term, originated by mental health professionals. People come to this article expected the professionally appropriate term, not some amalgam of popular usage. Could you imagine an article on, say, "radioactivity", that drew on such sources? Who want to read about PTSD from the viewpoint of someone who know little about it? That's a waste of everyone's time.TomCloyd (talk) 07:57, 25 November 2008 (UTC)

External Links (EL) restoration

I have restored some ELs deleted from the page w/o explanation. Several of these definitely look appropriate to the topic of PTSD. ResearchEditor (talk) 18:48, 30 March 2008 (UTC)

User:Arcadian was the reverter. You may want to discuss with him, he's an admin who's opinion I wouldn't discount easily (personally, I'm completely terrified of him). Also, being related to PTSD isn't sufficient. Sources must be reliable, contain information that is above and beyond what a featured article would contain, and all the other criteria of WP:EL. I've removed those links before, here, and my reasoning is in the edit summary. I can go through in detail for each link if you'd like. The editor in question, 70.190.94.117 (talk · contribs · deleted contribs · logs · filter log · block user · block log), has a history of spamming the EL section of PTSD-related pages [1]. These are not good links. WLU (talk) 20:31, 30 March 2008 (UTC)

I did have a question on two of the links:

http://www.ncptsd.va.gov

http://www.carlisle.army.mil/library/bibs/PTSD.pdf

Also, I have found a couple of other links that may be more appropriate as ELs.

NIMH · Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) - MayoClinic_com

Post-Traumatic Stress Disorder (PTSD) Causes, Symptoms, Treatment and Diagnosis on MedicineNet_com

Please let me know what you think of them. ResearchEditor (talk) 01:25, 31 March 2008 (UTC)

I wouldn't mind Arcadian's opinion on things. The first is dubiously acceptable, it is an organization about PTSD, but it's US-specific (see WP:CSB), and it's an organization, not an encyclopedic source of information. If there's an international organization I'd have no problem with it but US-specific is arguable, particularly with the DMOZ link that has its own links to associations. The second could possibly go in the further reading section but a better solution would be tracking down and using the refs in it to expand the page. Either way, it shouldn't be in EL, but further reading would be legit. The last three are basically all the same things - organization's summaries of PTSD. Really, I'd say none are good ELs because they won't contain anything beyond what PTSD would were it a featured article. They're adequate as sources, arguably one could be OK, but if you look in the disease infobox at the top of the page, there's already two general info links - MedlinePlus and eMedicine. Also, the Mayo clinic link is in the DMOZ page. Given that, I'd say none of the final three are good choices is greatly preferred over a bloated EL section. WLU (talk) 22:47, 31 March 2008 (UTC)

Agreed with the above. If I do find some better ELs on the topic, I will add them. ResearchEditor (talk) 03:06, 1 April 2008 (UTC)

Recurrent Trauma as a causal factor for development of PTSD

I have worked extensively as a social worker with torture survivors and in the majority of cases PTSD has occurred after more than one instance of trauma. In childhood trauma this can result in borderline personality disorder. The factor of pre-existing personality which predisposes the sufferer to development of PTSD thus is often the product of a previous trauma. Possibly a reduction n cortisol levels maybe part of this. In most cases torture of itself entails a repetition of successive traumas over a period of detention. I do not know of any reference for this, unless anyone else can help. Clients also report severe recurrent headaches, often down the back of the head, although this in many cases may be contributed to by neck and upper body injuries.--Streona (talk) 03:26, 11 August 2008 (UTC)

I concur with the emphasis in your comment on the causal priority of trauma. As a psychotherapist, I have successfully treated several hundred people with PTSD, across a range of ages. Not a single instance could be accounted to anything other than pre-existing traumatic experience. Multiple occurrences of trauma have been significantly more common, in my clinical practice, than single episode trauma. The present over-emphasis in this article on non-experiential factors distorts the professional consensus about causal factors resulting in PTSD. We MUST distinguish between passive (such as variation in brain structure or neurochemistry) and active contributors (such as traumatic experience) to outcome. They are not equivalent.

We need to straighten this out, and continue to improve the documentation upon which this article is based, which is presently MUCH better than it was even a short time ago. Let's just keep working, and keep our standards as high as possible. I'll soon be making some main article edits, as soon as I have my references in order. I resolve to be informed, but not biased, by my clinical experience, and urge others with clinical experience to adopt the same attitude. Anecdotal report is not adequate here. The topic is too important for that.

Tomcloyd (talk) 06:30, 1 November 2008 (UTC)

Time Lag between Trauma and Diagnosis of PTSD

My understanding is this- that PTSD is distinguished from Acute Stress Reaction because, whilst ASR is immediate but transitory, only if symptoms persist after a given length of time can the condition be called PTSD, which is not transitory but chronic. This is not addressed in the article except to say that the symptoms must ast for a month and I thought I would ask for opinions before making an edit. My understanding is that DSM-IV requires 3 months to elapse, but ICD-10 has 6 months. I suggest that the latter is more useful, as according to the Kings Cross Trauma Centre in London, the mind takes about 6 months to synthesize a traumatic experience and intervention during this period can interrupt this process. Studies of survivors of the Piper Alpha oil rig fire have indicated marginally worse outcomes for those who received therapy within the first 6 months then those receiving none.--Streona (talk) 08:15, 4 September 2008 (UTC)

"Cultural references" section of article

All four members of the Beauty and Beast unit of Metal Gear Solid 4 demonstrate severe examples of PTSD manifesting in various forms/emotions. I was wondering if anyone cared to add them to this section or if that would even be a good idea. aelphais (talk) 20:02, 24 October 2008 (UTC)

Well, there are at least two problems with this idea, but first I will agree that it is entirely possible to observe people who quite likely could have PTSD, in our daily lives, and in movies and the theater. It IS more common than even many mental health professionals perceive (I have an excellent reference on this - but it's not at my fingertips), according to our best epidemiological studies. So, your observation is interesting and quite possibly correct.

But...most fundamentally the problem is that one does not diagnose PTSD at a distance. We also don't do it casually, especially if living people are involved and we're speculating in a public place. This diagnosis requires documentation of certain types of personal history, which documentation must include both objective and subjective elements. Only then do we document current symptoms as meeting the established criterion for diagnosis. We need to know both that certain things happened to someone, AND that their reaction was extreme, long-enduring, and on-going. I don't believe you have such information. That's the problem with attempts to diagnose at-a-distance - it's too easy to misfire, and you cannot do it convincingly.

Secondly, this sort of material really isn't necessary or useful in a key article in the psychology / mental illness / psychopathology collection in Wikipedia.

Finally, even if you are entirely correct, and can document that, how would inclusion of this material be a "Cultural reference"? Such material, if I understand the notion correctly (and I do have an MA in Cultural Anthro.) it's about references (as opposed to manifestations) to some technical concept, in popular culture. This is interesting because such references constitute a kind of "cross-validation". Great truths DO tend to crop up in multiple contexts, after all.

Tomcloyd (talk) 04:23, 1 November 2008 (UTC)

Compared to a previous version of this article, it seems that the "cultural references" section has grown in size but is now, like such sections in many articles, a poorly organized list of trivialities deposited by fans of various books and TV shows. The previous version was more concise, more readable, did not mention so many non-notable examples, and in my opinion ought to be restored. The one improvement in the current version is the shortening of the Carlin monologue, which previously was quoted in its entirety. Any thoughts?

Zefryl (talk) 03:53, 8 November 2008 (UTC)

I've gone ahead and pared down what was listed there. Deciding what does and doesn't go into these sections is somewhat arbitrary -- I decided to leave in the paragraph about PTSD in film since this is pretty common, and the text on Wodiczko and Carlin since these are both significant cultural figures making (arguably) interesting statements about PTSD. I removed all text along the lines of "this one character in this book I like could maybe have PTSD," since I don't see what this adds to the article. Criticism welcome, but I think we can agree that this section should be a bit more focused than a laundry list of "in pop culture" references?

Zefryl (talk) 05:00, 18 November 2008 (UTC)

It's much improved, I think. It's worth pointing out that this is at most a minor section of this article. It should appear to be minor in importance, and really should only be about apparent references of "the culture" (meaning elements of human culture not professionally involved with PTSD) to something which it SAYS is, or which appears to be, PTSD. Those are genuine "cultural references", as opposed to some writer's opinion about something in the culture, like a character in a movie, which seems to the writer to manifest PTSD. THAT is not a cultural reference.

TomCloyd (talk) 07:29, 25 November 2008 (UTC)

Treatment section deficient

As a clinical researcher on PTSD, I find numerous problems with this entry. First, lengthy swaths of discussion of mediation and moderation, with confusing diagrams, are likely to dissuade the casual reader and add little to real understanding of the topic. Second, the treatment section, which should presumably interest many readers, is a mess. I just erased the assertion that psychodynamic psychotherapy is an effective treatment for PTSD, since there is in fact precious little evidence to support that wished-for assertion. —Preceding unsigned comment added by 68.161.205.74 (talk) 13:14, 23 January 2009 (UTC)

"The author believes . . ." - inappropriate sourcing for article ???

Under the section Comorbid substance dependence the first paragraph reads:

"Recovery from post traumatic stress disorder or other anxiety disorders may be hindered or even worsened by alcohol or benzodiazepine dependence. The author believes that benzodiazepines have no place in the treatment of anxiety disorders."

"The author believes . . ." ??? This kind of statement has no place in Wikipedia. (And which author would that be, anyway?)Daqu (talk) 21:56, 24 January 2009 (UTC)

I removed the sentence as suggested.--Literaturegeek | T@1k? 17:23, 25 January 2009 (UTC)

Moderator and mediator variables section removed

I have to agree with 68.161.205.74's comment above that the lengthy and somewhat technical discussion of mediators and moderators that had been in the risk/resilience factors section was "likely to dissuade the casual reader and add little to real understanding of the topic." Much of this section read like a research report, going into unnecessary detail on specific instruments used in various research studies, for instance. The more general information on the difference between mediator and moderator variables, while important, does not really belong in a general article on PTSD. It might be happier in existing articles on mediators and moderators, or in a more specialized article, for instance on moderators and mediators in psychiatric research. I therefore removed this section. While I considered retaining information from the two research articles discussed, I removed this as well. The first article showed associations between strong social support and attachment and lowered PTSD risk, which point is already made in this article. The second was based on a sample of healthy undergraduates and focused on forgiveness and avoidance. Although the text describing this article was replete with references, no reference was provided for the article itself.

I do feel bad removing so much material that someone clearly put a lot of effort into, and I do think some of this material could be useful in other articles. If I was overzealous and other editors think some of this information does belong in this article, please take a crack at it/ -Zefryl (talk) 02:18, 30 January 2009 (UTC)

I think you did the right thing. Digressive material is particularly damaging to an article on a complex subject. Carry on! TomCloyd (talk) 10:07, 5 February 2009 (UTC)

Ignore him. Please, STOP. Zefryl, Step back and prove your intelligence to the world in a way that does not effect everybody else you are investigating. SIT DOWN, BOY.76.180.55.81 (talk) 07:57, 3 April 2009 (UTC)

That's a personal attack, not a contribution. Please make demonstrably reasoned assertions here, or refrain. Zefryl appears to be acting responsibly - explaining his actions, and offering justification. I did the same, in commenting about his action. You did nothing of the sort. Please reconsider your style of response, because it's not serving to move the quality of this article forward. TomCloyd (talk) 23:17, 3 May 2009 (UTC)

confusion about causes: psychological trauma vs. physical harm

I copied the following discussion from my talk page here for comment. -Zefryl (talk) 13:05, 10 March 2009 (UTC)

Hello, I noticed that you said that the insertion of 'psychological' harm in the first graf of this piece is inaccurate. I believe you are wrong. PTSD can result from trauma that is either physical or psychological in nature. Regards,MarmadukePercy (talk) 01:55, 10 March 2009 (UTC)

Hi Marmaduke. Thanks for the message. The description in the first paragraph of the article is based on the 'Criterion A' definition of trauma given in the current DSM-IV-TR diagnostic criteria.[2] While it may be debatable whether PTSD can result from events where there is not even the threat of physical harm, that doesn't reflect the current official consensus, and so probably shouldn't be stated as fact in the lead paragraph's definition. Take care. -Zefryl (talk) 02:11, 10 March 2009 (UTC)

Thanks for your response. But don't you think it's a contradiction to insist in the first graf that PTSD is due solely to a physical threat, while insisting in the next graf that it's a psychological trauma? Clearly, the perception is what's at issue here. Whether something is a physical threat, or a perceived threat to one's personal boundaries is what's important, correct? And, ultimately, how does one differentiate between the two? Regards, MarmadukePercy (talk) 03:35, 10 March 2009 (UTC)

(1) I take the statement that it's a "psychological trauma" to mean that (part of) what's damaged is the psyhce -- i.e., as opposed to physical trauma like injury. I agree that the phrase isn't 100% clear though. (2) Evidence suggests that the overwhelming majority of traumata do in fact involve actual or threatened death or injury or a threat to physical integrity, consistent with the criterion A definition. Every common category of trauma reported in Kessler et al's epidemiological study, for instance, meets criterion A (ie: rape, molestation, physical attack, combat, shock, threat with weapon, accident, natural disaster with fire, witnessing someone being badly injured or killed, neglect, and physical abuse; and he was working under DSM-III, before the current definition was established).[3] (3) I still think the main point is that, while many people have many legitimate disagreements with DSM-IV, it does represent the current official consensus and the lead paragraph ought to reflect that. I have copied this discussion to the article talk page for others to comment. -Zefryl (talk) 13:02, 10 March 2009 (UTC)

Thanks for posting. Here is a page from the Mayo Clinic concerning PTSD.[4] It says that post traumatic stress disorder may result from physical trauma, but also from other events such as, for instance, childhood neglect or civil conflict. I have seen betrayal trauma also included among possible causes. I understand your point about the current DSM-IV definition, but I also wonder if the possible causes might be broadened a bit in the encyclopedia format. Regards, MarmadukePercy (talk) 19:49, 10 March 2009 (UTC)

I'm not an expert on this subject (I'm just studying it, currently), but I do have PTSD, so I just felt like throwing my two cents in. It doesn't surprise me that most reports of it happen to be about physical trauma; if PTSD comes from an emotional issue, it probably wouldn't be so easy to talk about it. I say probably because I of course don't know enough traumatized people to represent humanity as a whole. But, for the sake of an example, I actually had to learn how to talk about my problems as if I were in school. I never learned how as a result of being neglected. If I can have that kind of issue, I'm sure a lot of other people could too, so I believe it'd be better not to introduce the disorder as the result of physical trauma specifically. CorbeauBlu (talk) 00:40, 13 June 2009 (UTC)

"clinical" presentation of PTSD in this article - is it appropriate?

This article is so out of touch with real PTSD that it is honestly ridiculous. The very first sentence is a complete load of bull. I have PTSD and I'm not a soldier so I would appreciate it if you left your favoritism at home or your bar. I am very offended by the opinions listed here.MarmedukePercy was more than forthcoming and respectful about it. Change the freaking article NOW. I'm not screwing around with you. Debate about PTSD on your own time. The facts are black and white, and beyond that, I HAVE IT so please stop debating psychological trauma and neglect. If you really want me to make this into a special interests thing and contact the stigma alert center then I am MORE THAN HAPPY TO DO SO. TRY ME. CHANGE THE ARTICLE NOW. I won't be labeled a vandalist so please don't make this into a pointless wiki argument. You are wrong so just admit it and move the heck on. Preferably BEFORE you tick everybody else off that visits this page.76.180.55.81 (talk) 07:46, 3 April 2009 (UTC)

I work as a mental health social worker and my wife has suffered from severe PTSD after being tortured. It is my experience that PTSD is not taken sufficiently seriously by services, I feel because there is insufficient understanding and because people are actually afraid of it. It is not going to improve your day to find out bad things that happen to people that exceed your worst nightmares, so people - including so-called professionals shy away from it.In the UK Cognitive Behavioural Therapy is recommended for all PTSD sufferers. since the rate is 2-4 percent of the entire population , this is unfeasible without a lot more psychologists to do it. As for the number of EMDR practitioners, these are minimal. This article may be the first point of information for many people and it is better than nothing. In describing the subject as clinically as possible - which I think is the main cause of your anger - it helps people getting a grip and de-mystifies the whole area. There are people who think the syndrome does not even exist and has been invented by lawyers. Whatever you want to call it, it would be bizarre to think that someone could, say have their fingernails pulled out with pliers in an Iraqi dungeon and not suffer the inevitable psychiatric consequences.--Streona (talk) 08:45, 3 April 2009 (UTC)

Streona, I agree with your point about inadequate attention's being given to PTSD and related disorders by mental health (and other) professionals. This derives from inadequate attention's being given to these matters by the general culture. Mental health/illness issues in general are neglected. This is a long-standing problem. I do think the situation is improving significantly, but we still major work left to resolve the problem.

Secondly, a thoughtful, clinical presentation, here, is essential. PTSD is a challenging disorder, often misdiagnosed, and subsequently mistreated. We simply have to think our way out of this problem, so approaching the matter thoughtfully here is entirely appropriate. Nothing else is going to provide people with reliable information, and assist them in making informed treatment choices.

Third, if someone does not like the article, and is not in a position to act directly to improve it (as many will not be), it is helpful to suggest what changes you would like to see. Mere complaints don't give us much to work with.

Finally, we debate things because there IS disagreement or uncertainty. For example, the current DSM diagnostic criteria for PTSD require identification of a prior traumatic event. This often cannot be done with traumatic events occurring in early childhood, due to serious memory incapacity we all experience for that period of our development. No one was thinking about this when the original DSM criteria were developed. It is only through lengthy discussion and debate, some of which is still going on, that we've changed our thinking about who can develop PTSD, and when. This debate had to occur to clarify the situation. Debate is not only OK, it's vitally necessary. TomCloyd (talk) 23:49, 3 May 2009 (UTC)

Streona, I just read your post, and as a sufferer I really appreciate what you have written there about non-sufferers (and sufferers, too) being afraid of PTSD. And as a sufferer, I actually take comfort from seeing the condition treated with serious clinical attention, in this article at least. For me, that is much better than what happened to me, i.e. being diagnosed with a non-applicable (and very stigmatising) "personality disorder" for 15 years (by a doctor who probably made the misdiagnosis in order to get me into his private hospital's very expensive therapy course which was only admitting women - their PTSD program was only for male war veterans apparently, & they apparently let this determine their diagnoses! - grrrr) while one's (quite obvious, really, when one looks at the full story objectively) PTSD goes completely unnoticed & untreated.

I think that PTSD (and other similar conditions, I suppose) present a very difficult but also, in a way, an interesting challenge to us as a human society. I.e. if we can evolve to a point where many of us can effectively address (and of course, prevent, wherever possible) disasters happening to people & permanently harming them, wouldn't that be an amazing thing?

(While I'm here, I might as well say that I recently figured out that probably the best thing that the that hospitals I've been in (as an ER and later ER-follow-up-surgery patient) probably could've done for me (after dealing with the physical stuff, of course, and as well as having had really caring nurses & doctors, which doesn't always happen, especially with surgeons it seems) was to have provided a therapy animal. I really wish that could've happened. I think it might've helped. Does anyone know of anywhere this is happening? I'm in Australia & we're pretty backward here in regard to this stuff.) A wholistic approach is so important in treatment, don't you think?--Tyranny Sue (talk) 03:00, 11 July 2009 (UTC)

Posttraumatic stress disorder - meaning and relation of "stress" and "trauma"

... it is a disorder that occurs after stress which has been traumatic, or because it is characterised by stress that occurs after a trauma? I'd appreciate it if someone could clarify this, thanks. Maikel (talk) 14:52, 7 April 2009 (UTC)

Maybe I can clear up the confusion a bit. "Trauma" means that 'something has become broken'. It's not an either/or concept, but is graded. Nevertheless, we refer to something as "traumatic" when there has been a clear and significant loss of function.

Trauma can be physical, psychological, or both. PTSD is a psychological trauma disorder, and it arises when high levels of negative affect (feeling) are produced by the brain. A variety of things can cause this production, but the FACT of it is what sets up the conditions in which PTSD may develop. It should be noted that high levels of any feeling, and especially negative feeling, can cause serious loss of brain function. One can think of this as "too much power on the grid".

When these conditions are present, PTSD will develop if an individual cannot manage, process, or cope with the high levels of feeling. We see this failure to cope when individuals retain high levels of sensitivity to stimuli related to the traumatizing situation (whatever it was) for enduring lengths of time. The DSM standard is for a 30-day sustained hypersensitivity.

So, to recap: something happens (anything at all, basically), and the individual involved responds by producing high levels of negative feeling (fear, for the most part), which they are unable to resolve after a number of days have passed. If the pattern of sustained posttraumatic hypersensitivity meets the format criterion for diagnosis, the diagnosis is made. TomCloyd (talk) 23:33, 3 May 2009 (UTC)

External links trim

I've taken out all the external links except the DMOZ - there were a lot of blogs, links to advocacy sites and charities, news stories, and a couple generic information pages. Generic information is captured by the infobox, and external links should be for lengthy pages that can not be integrated as inline citations (WP:ELNO point 1). The inclusion of blogs, web fora and advocacy sites are out per ELNO 10, 11 and 13. That left just the DMOZ. A reminder that a small number of links isn't a reason to add more. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:19, 1 June 2009 (UTC)

I appreciate your cleanup - there was absolute junk the links list. However, there ARE some excellent resource sites, and I think they should be listed HERE, as part of our work to increase the quality of this article. Good external resources are a part of most major content statements with which I'm professionally familiar. AND, of course, we need to be watchful to pull the weeds that seem inevitably to appear. TomCloyd (talk) 11:48, 24 August 2009 (UTC)

Treatment section reorganized, cleaned up

I made substantial changes to the "Treatment" section. These consisted in reorganizing it and in removing unreferenced or poorly referenced statements. Here's a summary:

1. Added a "Psychotherapy" heading.
2. Some of the information under "Combination Therapies" was actually about pharmacological monotherapy (e.g., lamotrigine), so I moved these bits up into the "Medication" subsection.
3. Cut short very lengthy information on MDMA (Ecstasy), all of which was referenced from a website (the Multidisciplinary Association for Psychedelic Studies). I did leave in the two ongoing clinical trials of MDMA-assisted psychotherapy, now referenced with the NIH website clinicaltrials.gov. Also added a trial of hydrocortisone in conjunction with exposure therapy.
4. I removed lengthy information on ziprasidone (Geodon). The article claimed that this is one of the "most effective" treatments for PTSD, but this is only supported by one letter to the editor reporting on an uncontrolled study and by information from an advocacy website. (After these three changes, there is very little left in the "Combination Therapies" subsection. However this is an important section, and more well-referenced information can and should be added.)
5. I cut the "Other Techniques" section entirely. The "attachment therapy" claim came from a self-help book. The yoga claim was referenced by a news article about yoga being used among people with PTSD (i.e., no information on whether it's actually effective as a treatment). The meditation claim was supported only by an article about meditation in healthy people, not in PTSD.
6. Moved the "Comorbid substance dependence / Self-Medication" section to the end.
7. Finally, this statement was tagged onto the end of the Substance dependence section: "When considering any treatment it is important to consider validity ratings and testing protocols used. For example rapid eye movement has a low validity rating and genuine attmepts to falsify CBT(King, 1998) have shown it to have results not more effective than drugs or placebo." While this is a true statement, it wasn't connected or tied in to any other statement in the article, and seemed just thrown into the middle of the "Treatment" section at random.

Hopefully I didn't irritate too many editors here. I removed content simply out of the belief that the treatment information included here should be referenced using peer-reviewed research, and as it was much of it wasn't. -Zefryl (talk) 17:27, 17 June 2009 (UTC)

These edits vastly improve what what a really awful section. It's been high on my "rewrite" list for some time, and only substantial professional demands have kept me from taking action. You've done very well. However, the overtly slanderous statement about EMDR you quote above is simply bogus, not true as you suggest. The treatment section now reflects EMDR's actually treatment validity, as evidenced by very substantial research. This old argument is no longer worth referring to. EMDR works, when done right, and that statement is easily sourced. TomCloyd (talk) 02:18, 3 September 2009 (UTC)

Thanks, Tom. I'm a little confused what you mean about "the overtly slanderous statement about EMDR you quote above." I didn't write anything about EMDR, and don't have any problem with it. Zefryl (talk) 21:43, 12 September 2009 (UTC)

My error: I was not clear. The quote in your #7 above simply isn't supported by the clear majority of the peer-reviewed research on EMDR. As such it so distorts what we actually know about EMDR as to be slanderous, in my view. I'm very well informed on this matter. In any case, someone has completely and competently re-written the section on EMDR, and it is now in accord with the published peer-reviewed literature. I have no trouble with it, as written. Sorry for arousing unnecessary concern! TomCloyd (talk) 00:26, 28 September 2009 (UTC)

USA-centric nature of article focus and citations; also - need for statistics on gender

Would that be a fair assessment? (i.e. that the article is mostly coming from USA-based studies, etc. For example, the mention in section 1, 1.4 of Vietnam veterans - would there be an assumption that they are American-based ones? Not necessarily Aussie, Kiwi, Canadian or South Korean ones, perhaps, due to PTSD studies in those countries being so much less sophisticated & well-funded than in the US.) I'm in Australia, and I don't know about other countries, but PTSD is rarely diagnosed here, it seems.

I treat PTSD in the USA, and was educated here. You're right. The big push for the diagnosis came immediately right after the VietNam war, and in the USA. I think it's highly likely that the clear majority of studies on PTSD are on American vets. and non-vets (the latter being the largest category of PTSD victims).

There is NO reason to believe that the findings of research in USA on its citizens don't apply just find to people in other places. As for differential rates of diagnosis, I strongly suspect this is due to differences in awareness, not in the incidence of the disorder.TomCloyd (talk) 11:24, 24 August 2009 (UTC)

That brings me to another point regarding diagnosis statistics. Does anyone have any statistics on PTSD diagnoses across different countries & genders? Because from what I've read & heard it seems there has been a tendency for doctors (at least in Australia) to be more likely to diagnose females with things like BPD, while males are more likely to be diagnosed with PTSD.

Thanks.--Tyranny Sue (talk) 03:56, 11 July 2009 (UTC)

Gender: I have good sources on this and will be editing around this issue soon. Females are diagnosed with PTSD about twice as often as males, in fact. TomCloyd (talk) 11:24, 24 August 2009 (UTC)

Should be called 'Post-traumatic stress disorder'

Considering 'Posttraumatic' isn't a real word, and most sources seem to call it the other way. It had already been moved to that name once but changed back. i can't move it again. What happened? Dyld921 (talk) 15:36, 12 July 2009 (UTC)

If you look at discussion point #7 above, 'NO HYPHENS PLEASE', you'll see a discussion of this issue. The current consensus appears to be to follow the DSM nomenclature, which is without a hyphen. Mccajor (talk) 19:38, 17 July 2009 (UTC)

Problems with statements re: history of PTSD diagnosis / unsourced and inappropriate statements about veterans

I've flagged this section as having a number of issues and I've been trying to figure out how to clean it up, but I'd appreciate input from whoever created it. There are a number of contradictions in here that need to be cleared up.

For instance, "The diagnosis was removed from the DSM-II, which resulted in the inability of Vietnam veterans to receive benefits for this condition." What diagnosis? PTSD was coined to describe the Vietnam-era condition and later expanded to cover similar symptoms in people who suffered civilian injuries or assaults or sexual assault/abuse. There are a number of different names that captured various areas of PTSD symptoms, including 'battle fatigue' and 'shell shock', some mentioned earlier in the article. I don't have a DSM-II in front of me, but it's unclear to me as a psychiatrist exactly which diagnosis was 'removed from DSM-II'. And was it was removed in going from DSM to DSM-II in 1968, or was it somehow discredited/removed as a diagnosis while DSM-II was still applicable?)

Another issue is the unreferenced statement about 'highly-publicized suicides by veterans who feared losing their benefits'. This sounds odd and should have a citation, or perhaps be reworded after looking at the documentation (whatever that might be). Why would someone suicide because they *might* lose their benefits, rather than waiting to see if they actually lost them? How would someone else know? (This is not intended to dismiss the serious issue of suicide prevention among vets or the ways that many vets are currently being denied appropriate benefits, but those are separate topics.)

The section at the end that mentions two veterans who supposedly claimed PTSD made them watch child pornography or molest kids has multiple issues. The story cited on Murphy, for example, [5] says that his ex-wife reported he had had nightmares of rapes committed or witnessed while in Vietnam and that he wanted to re-enact them on children. Nowhere in the section on the legal issues does it say what Mr Murphy actually reported to police, or whether he's attempted to use it as a defense. As contributors to this article presumably know, PTSD does not cause people to become child molesters, and it certainly does not cause a change in sexual orientation to pedophilia or ephebophilia. I would suggest that these two references either be removed, or reframed in some manner around 'misunderstandings of PTSD' or 'legal implications of PTSD'. Thoughts? Mccajor (talk) 20:25, 17 July 2009 (UTC)

Oh, I absolutely agree. There are many problems with this article, most appearing to originate from editing by non-mental health professionals (I say that because the errors I'm seeing wouldn't be made by someone with graduate training in psychotherapy and clinical experience with psychological trauma). We need to clean this up, and focus on priorities. We can, I think, move it much closer to approximately a Class A status.

Your reference to the alleged "disappearance" of the PTSD diagnosis (that's obviously NOT what happened) is completely on target. The cited article says something else altogether. I'll fix this in a day or two, when I have more time.

There is much more - although I don't want to fail to note that there is certainly some good work in this article as well. However, as someone who specializes in the treatment of PTSD, I don't want my clients coming to this article - just yet. I will soon post here a list of proposed changes and additions. All will move the article in the direction of a more professionally responsible statement, I think. TomCloyd (talk) 10:57, 24 August 2009 (UTC)

As of 2009.11.12, all issues raised here appear to have been resolved. TomCloyd (talk) 19:29, 12 November 2009 (UTC)

2009.09.29 - edit of "Comorbid substance dependence"

I have removed the following edit, inserted at the end of this section, for the following reasons:

• It is blatantly off-topic for this section.
• It has multiple gross spelling errors.
• It is not correctly formatted (the citation is missing an end tag).

If the contributor has not even enough care to check his/her work, I suggest they are not ready to contribute here.

Mental healthcare is not readily available all around the country. And where it is available, there are limited health care plans. In effect, military veterans are often hesitant to recieve treatment. They veiw being diagnosed with a mental disorder as a sign of weakness,may result in negative career opportunities and weary abot the medication that is offered and its side effects.<ref.>Meredith LS, Tanielian Tand Jaycox LH, "Mental Health care for Iraq and Afghanistan War Veterans", Health Affairs Vol. 28,No.3 May/June 2009 pages=771-782. {{cite web}}: Missing or empty |title= (help); Missing or empty |url= (help); Missing pipe in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)

--TomCloyd (talk) 22:01, 29 September 2009 (UTC)

Add signs and symptoms of the condition?

Could use a section outlining the signs and symptoms of the condition.Doc James (talk · contribs · email) 02:18, 12 November 2009 (UTC)

Agreed. While this might be thought of as synonymous with the "diagnostic criteria", that really isn't true. Most people with PTSD probably present with depression, for example (and get diagnosed with that as well...). Will work on this tonight, along with inclusion in the Epidemiology section of key elements of the WHO dataset which we've been discussing on our respective talk pages - I want act on that while I'm close to the information. Life moves on quickly. TomCloyd (talk) 03:30, 12 November 2009 (UTC)

RETRACTION: For reasons I will shortly be posting in a separate section on this page, I no longer think this section is a good idea. TomCloyd (talk) 04:39, 26 December 2009 (UTC)

Re: replacement of "patient" with "person"/"individual", etc.

I fully realize this may be somewhat controversial, but here's my rationale:

FIRST - In a medical context - i.e., any treatment or research context managed by physicians and their associates, those receiving care are commonly referred to as "patients".

In a non-hospital mental health treatment context - i.e., a regional mental health clinic, or the office of an individual treatment provider other than a psychiatrist or psychiatric ARNP, those receiving care are only rarely referred to as "patients". By non-medical care providers, it has been the custom for some time to refer to them as "clients", or simply as "individuals", and so on. The term "patient" is deliberately avoided, in order to indicate that the care provider/receiver relationship involved is NOT the same in nature as in a medical context, in at least two ways:

• it is more consultative, and more egalitarian, than has been traditional in medical contexts; and...
• it is more health-oriented, as opposed to disease-model-oriented.

There are some other, more subtle reasons, as well, and had I more time, I'd love to write about them.

SECOND - The majority of actual mental health treatment, at least in so-called "first-world" countries, is provided by mental professionals whose training is in one flavor or another of psychology, not psychiatry, which increasingly is devoted solely to medication management. From an epidemiological standpoint, it is easy to argue that most recipients of treatment for PTSD, and other mental illnesses, are accustomed to being referred to by terms OTHER THAN "patient".

For these reasons, it therefore seems most appropriate to NOT refer here to PTSD victims as "patients". That's simply not what they're used to, nor will it be familiar to the majority of mental health treatment providers. TomCloyd (talk) 03:56, 12 November 2009 (UTC)

Avoiding the word "patients" is recommended in MEDMOS guideline, Wikipedia:Manual_of_Style_(medicine-related_articles)#Audience so I would support changing it to "individuals" or similar. I also agree with your reasoning. :)--Literaturegeek | T@1k? 12:19, 12 November 2009 (UTC)

For the record, I also agree with what you've said, Tomcloyd. MarmadukePercy (talk) 12:35, 12 November 2009 (UTC)

Wow. I'm just a bit surprised. I expected to take some heat on this one (and may yet!). Thanks for the support - and especially for the style manual reference. About that I had no idea at all. Most interesting (and encouraging). I'm encouraged to think I may get away with this - which I think is reasonable, in truth. TomCloyd (talk) 12:51, 12 November 2009 (UTC)

Yes sounds like a good idea. We are instructed to do this on all pages as mentioned by LG.Doc James (talk · contribs · email) 16:34, 12 November 2009 (UTC)

I don't know if this qualifies as "heat," but let me point something out: in some contexts, "person" is too ambiguous, and a more careful rewrite is necessary. For instance, the second paragraph of the lead section currently reads:

“ It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve the death of a person, a threat to the person's or someone else's life, serious physical injury, an unwanted sexual act, or a threat to physical or psychological integrity, overwhelming the individual's psychological defenses. ”

Note that the word "person" is now used to refer both to the !patient, and also others. It makes for pretty difficult reading. For all the problems with the word "patient" (and I agree it's not ideal), it does make it very clear to the reader which person is being referred to.

Resolved? Point well taken - nice catch! I have completely rewritten the second paragraph of the lead section; it's now briefer, simpler, and clearer. TomCloyd (talk) 19:52, 12 November 2009 (UTC)

As a separate note, I'd say the description of causes in the "causes" section reads much more smoothly than that in the lead section overall, and maybe could serve as a model for how to rewrite the lead. -Pete (talk) 16:56, 12 November 2009 (UTC)

Yes, for sure. I think the two pieces of writing are now approximately equivalent in clarity. Yes? No? TomCloyd (talk) 19:52, 12 November 2009 (UTC)

Yes, resolved quite nicely, thanks. -Pete (talk) 20:56, 12 November 2009 (UTC)

PTSD/ASD, misunderstanding and misdiagnosis

I want to recommend this link for everyone on the issue of PTSD/ASD:

http://www.ptsdforum.org/showthread.php?t=11735

Basically, there's a major misunderstanding in terms of what PTSD is and how it relates to the less severe disorder, ASD. In both cases the vicitim will exhibit symptoms of post traumatic stress, but PTSD is due to a permanent physiological change within the brain which is life long and for which there is no cure. ASD, however, may encompass the same symptoms as PTSD, and the symptoms may go on for many months or even years, but if the person fully recovers no permanent damage has been done. Furthermore, delayed onset may occur in the case of ASD as well, even though this possibility is not included in the DSM-IV. ASD is very often misdiagnosed as PTSD, even by claimed professionals. We should make a distinction and clarification of this situation in both the ASD and PTSD articles. —Preceding unsigned comment added by Shoplifter (talk • contribs) 09:01, 20 November 2009 (UTC)

This is simply wrong. To say that "...PTSD is due to a permanent physiological change within the brain which is life long and for which there is no cure..." is to spread gross misinformation. When the symptoms of PTSD are no longer present, and do not reappear, we have a cure. I have personally accomplished this cure with so many people that I couldn't quickly give you an accurate estimate - and each cure is documented with careful records of the treatment and the symptom resolution.

PTSD can be lifelong when it is does not receive appropriate treatment. Since it often is not even correctly diagnosed, and since a substantial percentage of the cases which are correctly diagnosed are treated incorrectly, it is probably factually correct that most PTSD that lasts past one year is lifelong. However, treat it correctly and it's over. (Complex PTSD is, however, often not completely resolved by professional treatment, probably because its developmentally early-onset causes non-normal brain development.)

The misdiagnosis which too often occurs is usually due to inadequate intake assessment. A professional sees the depression with which it usually presents, makes that diagnosis, then goes no further. Big mistake. Other misdiagnoses also occur, but that's the big one I've most often seen.

You are citing a discussion forum thread that is simply gossip - there is no primary source evidence there at all - indeed no source of any kind for the claims made. (But then there couldn't be, since the claims made are untrue.) PTSD is NOT primarily an organic disorder. Professional consensus simply does not support that view. That there are organic correlates of PTSD, however, is hardly news, nor should it be a surprise, since PTSD is a disease of the brain. ASD is simply PTSD that resolves spontaneously (as most PTSD does) - within a somewhat arbitrary 30 day period. Other than that, the two are indistinguishable.

I strongly suggest that you exercise more caution in what you believe and write about. Psychopathology is a complex subject. If you have not specialized training in PTSD, you would do well to defer to those who do. Spreading gross misinformation can cause real injury to people.

I have reviewed the treatment section of the PTSD article for which this is the talk page, and it's pretty good. It's still capable of being improved, but essentially correct. PTSD is a type of learning disorder - a problem with what has been learned from experience. There is no primary drug treatment for it. There are two validated psychotherapy treatments - Cognitive Behavioral psychotherapy, and EMDR (I do both - and consider the second to be a variant of the first). Both work quite well, when done right. Treating PTSD is what I do for a living. You can believe me or you can believe those folks on your discussion forum. Who do you think has the best information?

TomCloyd (talk) 13:43, 20 November 2009 (UTC)

Let me just make a short reply. I'm not a trained professional on this subject. I have suffered a trauma and have recently experienced symptoms (on-going for the past six months). Since I came down with symptoms I searched the web for information on this topic. The information given to me has been relayed by others, primarily PTSD sufferers, albeit some with considerable expertise of the clinical discussion.

This is not about prestige for me. I want to believe what you state is true, and looking at your personal page I understand you are obviously involved with this issue on a daily basis in your professional life. However, I still believe that what I've learned is accurate due to the extensive experience of the people on the forum on which I have been informed. I have also learned that misinformation is common even among professionals.

You claim that PTSD if treated within one year will hinder permanence. This sounds to me like misdiagnosed ASD. I concede, however, that I'm not qualified to get into an argument on this issue. I have made a post on the board to which I referred earlier and hopefully others will join in so we can get a good discussion going here with concomitant improvements in the relevant articles. Shoplifter (talk) 14:16, 20 November 2009 (UTC)

Wikipedia is based on research. Research can be found through pubmed. This study for example says "early treatment of PTSD may prevent chronicity and should be considered once symptoms of PTSD persist for three or more weeks following trauma" [6] So as we discuss this please quote research. Doc James (talk · contribs · email) 15:21, 20 November 2009 (UTC)

Shoplifter, sorry to hear of your trauma and its effects. If you get treatment from a competent psychotherapist who has success with PTSD, you likely be pleased with the results. If your PTSD only just started recently, it can be quickly resolved. If it isn't, your treating professional is incompetent.

"Prestige" is not the issue. Correct, validated information - analytic models and treatment interventions - is. Anyone can acquire and use such information, if you know where to look and how to make sense of what you find. Mere "experience" isn't especially useful. I know a number of people with cancer, or with depression (or with PTSD!!!), who have a ton of experience, and absolutely no competence whatsoever in treating their disorder. Often people heavily impacted by a disorder have real trouble thinking rationally about their experience, for reasons I can well understand. The experience I advise you to seek is that of scholars, researchers, and clinical professionals. Why would you consider anything else?

The distinction you make between PTSD and ASD is invalid. The two cannot be distinguished from PTSD except by its temporal relationship to the psychologically traumatizing event or events. As with all else, experience with these disorders does not give us better information than we have from clinical treatment trials and peer-reviewed reports we have of them.

I hope these thoughts are useful to you, and to others.

TomCloyd (talk) 23:18, 20 November 2009 (UTC)

First of all, I do not suffer from PTSD, merely intrusive thoughts. Please don't make any claims about my condition. It's quite unsettling for a person who has a current battle with a psychological issue. Second, the difference between ASD and PTSD lie in whether the biochemical make-up of the brain has changed or not. This is the real issue here. You carry the burden of proof for your claim that PTSD is curable since this would require an MRI scan prior to after treatment to show that the biochemical change has in fact been reversed. ASD sufferers most certainly may experience intrusive thoughts and all other symptoms of PTSD. The four weeks duration is inaccurate, and as everyone reading the DSM should know, time frames are only made in order to give some uniformity across diagnosis. This is another major issue of misinformation - consider the diagnostic criteria for acute PTSD. The three months of symptoms referred to are not a one time event but rather recurring bouts of symptoms. Shoplifter (talk) 01:28, 21 November 2009 (UTC)

(undent) I provided a ref now your turn :-) Doc James (talk · contribs · email) 01:33, 21 November 2009 (UTC)

Hey man, I appreciate the effort. What I can tell from that particular report, they're suggesting effective therapies for PTSD treatment. PTSD can of course be treated. The claim to be substantiated is whether once the biochemical make-up of the brain has changed, it is possible to reverse and thus cure the condition. This, I claim, is not possible. Again, whoever is making the claim of an existant fact carries the burden of proof. Shoplifter (talk) 01:38, 21 November 2009 (UTC)

One more thing. Let me first say that I retract my prior statement of not getting into an argument on this issue. Not because of belligerence or claim of educational merit, but because even a layman like myself can see through the misinformation spread on this topic. I am highly concerned about Wikipedia being a good source of information on this issue as this was the first place I turned to for guidance once I came down with symptoms.

TomCoyd wrote the following:

"ASD is simply PTSD that resolves spontaneously (as most PTSD does) - within a somewhat arbitrary 30 day period. Other than that, the two are indistinguishable."

This is patently erroneous. If this was true, a chemical imbalance would've occured in the brain of the ASD sufferer which was resolved within one month. Concurrently, there should be a tonne of MRI scans readily available showing how the imbalance was reversed.

Let's look at this from a common sense point of view. Why are there two different diagnoses? Because they are not the same. PTSD is due to a change in the chemical make-up of the brain. ASD is not. If ASD was PTSD, why would they have different descriptions? This is a classic case of a therapist having misunderstood the criteria for diagnosis.

For accurate information on the difference between PTSD and ASD, check out this link:

http://www.combatptsd.org/content.php?r=4-Acute-Stress-Disorder-(ASD)-vs-Post-Traumatic-Stress-Disorder-(PTSD)

Also, this is highly relevant to our discussion:

Study Says Post-Traumatic Stress Disorder Being Over-Diagnosed

http://www.ptsdforum.org/showthread.php?p=130356&highlight=acute#post130356

My above stated challenge remain. Whoever claims that PTSD is curable (not treatable, which everyone agrees it is) must provide a report showing how the chemical imbalance in the brain of the sufferer has been successfully reversed. If this can't be proven (which, unfortunately, is the case) it is high time that we see too it that the PTSD and ASD articles are updated with accurate information in accordance with DSM-IV and the reality of this devastating illness.

Let me finally say for the record that I'm certain that everyone involved here wants the best for their patients and the people seeking information. But this problem with misinformation has been going on for to long and is very troublesome. It does not help to give people false hope. We have to get the facts straight. I'm looking forward to a constructive discussion on this issue. Shoplifter (talk) 02:33, 21 November 2009 (UTC)

Yes but Wikipedia is ideally based upon peer reviewed literature. If what we have does not reflect the literature than it should be changed. We cannot base it however on forums. I will not really get involved in the arguements I am only explaining what this conversation needs to be based on.Doc James (talk · contribs · email) 03:31, 21 November 2009 (UTC)

Shoplifter - My time is, regretably, seriously limited, and my first commitment here is to work on improving the PTSD article. This is NOT the place for a forum-type conversation, as the header to this page states. The PTSD article, if it is to best serve the people who come here, needs to reflect our best knowledge. IF you wish to correct something in the article, please do so by referencing material from a peer-reviewed primary source or secondary source article or book, or provide on this talk page references to such material so that others can make the correct.

I am glad that we all agree that providing the best information possible in the article is our goal. There is a common consensus, in the Wikipedia community about how this is to be done, and I think those guidelines are well thought out. I invite you to work with us within those boundaries, if you wish. TomCloyd (talk) 09:05, 21 November 2009 (UTC)

Here is the problem with your argument. You're asking me to prove that something doesn't exist (i.e., that PTSD can't be cured) because you can't prove that it can be cured (which it can't). It's not a question of citing peer-reviewed literature to support that something is not possible, since they don't do studies in order to establish a negative fact.

While the delineation between ASD and PTSD (which hinges on curability) is the basis of our dispute, it is the consequences of being in the wrong on this issue that worries me and which have troublesome effects on the articles. As TomCloyd has illustrated, if you inaccurately believe PTSD to be curable you will misread the DSM-IV and treat every case of post traumatic stress as PTSD whilst what you're in fact is dealing with is ASD. Ipso facto, you now have the problem of over diagnoses due to misreading of the clinical guides (DSM-IV in particular). In other words, the articles must be changed to comport with the proper interpretation of the DSM-IV. This does not require referencing peer-reviewed sources, merely fidelity to the primary source in question. Shoplifter (talk) 09:56, 21 November 2009 (UTC)

(undent) Studies are not done with an answer in mind. Lots of negatives exist. The Women health initiative was done and showed the estrogen does not work. But if as you say you opinion is not verifiable there is nothing further to discuss.Doc James (talk · contribs · email) 12:38, 21 November 2009 (UTC)

I don't like repeating myself, but will all respect to you, I find it necessary. Of course a study can have a negative result! But you do not conduct a study to prove that something isn't the case. You've gotten the question upended - it's not me lacking verification, since I'm not trying to prove anything. I'm saying that PTSD is due to a biochemical imbalance in the brain which can't be reversed (which is accepted among more than the vast majority of physicians and psychiatrists with experience treating PTSD, and the factual basis of which is already stated in the article page). You are, however, making an unsupported claim of curability. Thus, you must prove this to be true. As I've written previously, the problem is the consequences as they pertain to the erroneous interpretation of the DSM-IV and concomitant spread of misinformation.

The problem lies with therapists who are not reading the DSM properly and are using PTSD as their primary diagnosis for post traumatic stress, wrongly diagnosing masses of people with a disorder they do not have. The practice used to be choose the lesser evil among the twenty plus disorders available for diagnosing anxiety and then moving up the scale if symptoms persisted. This is a very real and troubling issue. Shoplifter (talk) 13:37, 21 November 2009 (UTC)

The bottom line remains. If you can't show evidence of a biochemical imbalance having taken place and subsequently having been reversed (MRI scans would be necessary, which would be available en masse if as you claim a six months bout of traumatic stress where symptoms completely disappears is actually PTSD and not ASD) then the diagnosis is wrong. This is the difference between ASD and PTSD, and we should all be concerned that the proper delineation is made here at Wikipedia where so many people turn for information. Shoplifter (talk) 13:43, 21 November 2009 (UTC)

If you have evidence for this argument add it to the page to provide balance. I am hardly convinced of the pathophysiology of PTSD that you mention. Uptodate states "While much of the pathophysiology of PTSD is unclear, interesting findings are accruing from research being done in the area. Studies using MRI scans have shown that there is decreased hippocampal volume in patients with PTSD compared with matched controls"[7] The MRI stuff is in the research stages. If it was so cut and dry we would diagnose PTSD with an MRI and it would be a neurological not a psychiatric disorder. CBT by the way does changed the brain as per this paper.[8]

The diagnosis of PTSD does not even take into account MRI data so this is not how one distinguishes PTSD from ASD.Doc James (talk · contribs · email) 13:54, 21 November 2009 (UTC)

"signs and symptoms" section: Four-factor models and insufficient extinction

I just made two changes I want to quickly summarize. First, I added some information on the fourth cluster of PTSD symptoms that emerges in factor analysis (nicely summarized here) to the "signs and symptoms" section. (Hopefully an uncontroversial edit.) Second, I noticed that a few sentences about PTSD being a "disorder of insufficient extinction" were scattered about the article, mainly in places where they didn't fit (including under "Signs and symptoms," "Neuroanatomy," and under "Genetics"). To avoid redundancy, I moved this all to the neuroanatomy section and deleted the other instances. -Zefryl (talk) 00:03, 6 December 2009 (UTC)

I like your second edit. Hadn't caught that there were multiple references to the "insufficient extinction" idea.

The first edit concerns me mainly because there's a deeper issue to be resolved, into which you dive with your edit:

• "signs and symptoms" is a medical concept (which I DO much like) which simply isn't used in the real world of PTSD diagnosis and treatment - not that I have ever seen. I've not seen it in research literature either. I don't think it belongs here, for that reason.
• the section title is illogical: it refers to signs and symptoms, and then makes no attempt to distinguish the one from the other (well, it shouldn't, should it - as it that would be an original contribution, given that this distinction doesn't exist in the literature); to not follow through with the distinction in the section content makes little sense to me.
• the content of the section is simply a rehash of the diagnostic criteria in the DSM-VI. While such criteria ARE likely to be symptoms, they surely are NOT "THE symptoms of PTSD", and are not presented as such in the orignal source; thus they should not be so presented here, either. They are instead symptoms with field-tested discriminant validity: they generally distinguish those with PTSD from those without. THAT's their raison d'etre. To present them as "the symptoms of PTSD" is misleading. Example: much PTSD presents with depression (often subclinical, but not always) as a symptom. However, depression has many causes, and thus does not well distinguish those with PTSD, and so is not in the DSM-IV disgnostic criteria.

Bottom line: I propose doing away with "Signs and Symptoms" altogether. There simply is no consensus in the professional community that would justify its presence here. That community does not, in fact, even talk or write of PTSD in such terms. It's just alien.

The "diagnostic criteria"/"symptoms" confusion is very common, probably because most people have no idea how the DSM diagnostic criteria are developed - that they are a subset of symptoms with highest possible discriminant validity. We do not have to perpetuate that confusion here, surely. I plan on fixing this problem here in the very near future, and would already have done so, had I been able to find the time. TomCloyd (talk) 07:08, 6 December 2009 (UTC)

"Society and Culture" - reasons for deletion of this section

Editors wishing to review the deleted section as it was prior to deletion can view it here

I have been distressed by this section of the article for months, but haven't had time to act on my concern until now. I have deleted the entire section for these reasons:

1. The overwhelming majority of the material here is either unsourced or uses primary sources. It has been flagged with "citation needed" notes for quite some time, to no effect whatsoever. Unsourced assertions are clearly not acceptable in Wikipedia articles. Use of primary references is also virtually always unacceptable. Such references, to be useful, must be interpreted and placed in context, etc. Doing that constitutes an original contribution - also unacceptable in Wikipedia (see Wikipedia:No original research).
2. The three cited sources which do appear in the article are clearly not to peer-reviewed journals. Mere opinion, cited, is still mere opinion, and not necessarily a legitimate secondary source.
3. All attributions of the existence of PTSD in a character in a work of fiction (story, novel, movie, video game, etc.) are suspect, unless they appear in a documentary involving the commentary of qualified diagnosticians. No one I know in professional mental health would serious ascribe PTSD to an individual after merely viewing a film or reading a narrative description of their behavior. Diagnosis requires careful history taking coupled with careful matching of an individuals symptoms to an acceptable list of diagnostic symptoms, which then must appear in the individual in sufficient number and for a sufficient period of time BEFORE the ascription of the diagnosis may be made. Getting this information virtually always requires a carefully structured interview. There is no other way.
4. The casual and probably erroneous references to supposed examples of PTSD which have largely characterized this article serve only to propagate and perpetuate folkloric notions of the disorder, rather than to educate readers in what individuals with PTSD actually look, sound, and act like. This is not useful to anyone (with the possible exception of video game makers!).
5. During this past year that I have been watching this article, this section has repeatedly been a magnet for casual "drive-by" edits - "Oh, I know a video game which has PTSD in it...". The result is a body of material of increasing size which, for the reasons given above, really shouldn't be here. The only way to stop this is to remove the magnet.

TomCloyd (talk) 23:04, 25 December 2009 (UTC)

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This information still looks relevant to me. If any of those sources describe PTSD wrongly, then say so, to warn readers that this and that sources are not reliable. This looks somewhat like a case of "one man's cruft is another man's relevant matter". Anthony Appleyard (talk) 07:28, 26 December 2009 (UTC)

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Anthony, I find your response unacceptable. I have restored the deletion, but placed a link to it at the top of this section.

My reasons for not accepting your reversion:

• You assert that the deleted material is relevant. It may be, but how could we know? It is not MY obligation to validate the material. It the job of the original editors. That they failed to do so was my reason for inserting "citation needed" tags - in some cases months ago, and is addressed in detail in my reasons number 1, 2, and 3, above. With extremely rare exception, primary sources should not be used in Wikipedia.
• Your reversion is based solely on personal point of view. I carefully detailed my reasoning for the deletion, and cited established Wikipedia policies. MY point of view is not cited, and not relevant. You have addressed none of the points detailed by me, saying only that you disagree. That isn't good enough. Why bother to approach this rationally at all, if that's the nature of your response? This isn't about opinion. It's about form, as is all reasoning processes. The material is of the wrong sort for Wikipedia inclusion, as I have argued above. I'm certainly willing to yield to better thinking...but where is it?

Had I deleted the material with only cursory comment on the "edit summary" line, I could understand your reversion. I did not do that. What you did was ignore my reasoning and respond as if I were being impulsive or poorly thought out - hardly the case. My action was carefully supported. I don't see the support for yours. I welcome refutation or improvement of my arguments - that's a principal reason or the Talk page, is it not?

This is very important article in the Psychology division of Wikipedia. It makes no sense to tolerate junk such as has been appearing in the deleted section, given that people come here hoping for accurate information. We owe them our best. My concern is professional. I'm too often having to push back again gross ignorance about PTSD in the general population, and even with my clients. To propagate it here is inexcusable. If material is inadequately sourced, it doesn't belong here. That's official policy.

• "reverting is not to be undertaken without good reason" (You might want to review the source of this quote - this IS Wikipedia policy.
• These distinctions are of central relevance: Primary, secondary and tertiary sources
• And please look at this Wikipedia:Arguments to avoid in deletion discussions. I know this is not "policy", but it's well thought out, and is listed as a resource in several official policy articles.

I welcome thoughtful comment on this deletion (of course).

TomCloyd (talk) 09:47, 26 December 2009 (UTC)

Your deletion was good and I agree with your reasoning Tom. I think that it should be redeleted.--Literaturegeek | T@1k? 12:16, 26 December 2009 (UTC)

PTSD and DBT treatment

Does anyone had any success who is living with PTSD with the DBT treatment if so please respond to this topic and write about it.

Thanks

Ben Vanderleij —Preceding unsigned comment added by 142.59.66.244 (talk) 16:36, 28 December 2009 (UTC)

I'll reply briefly, but first - this is not a place to discuss PTSD treatments, but only to discuss the PTSD article, as stated at the top of this page.

As for DBT - it is designed as a treatment for Borderline Personality Disorder, and is validated (shown to work, in clinical research) for this as well. That said, it has also been found to be a useful intervention with a variety of mental health issues involving affective flooding (i.e., too much feeling, coming too fast). E.g., I have seen it used to help disturbed adolescents improve management of their feelings, in a residential treatment facility. As to its application to PTSD, I don't know of any reported successes, although there are some reasons to expect that it would be helpful. However, I would not expect it to be a treatment. Rather, it would simply assist with management. PTSD should be treated, not managed, so that symptoms remit and the disorder ceases to exist.

There are two research-validated treatment approaches known to succeed with PTSD, and these really should be one's first intervention choices - EMDR and Foa's Cognitive Behavioral Therapy model. As an example of the importance of choosing the right approach, consider the following:

• DBT requires a group of people and weeks of classes, whereas EMDR can get the job done in a single session, with single-episode trauma resulting in PTSD.
• DBT seeks to train participants to more adaptively manage their affective dynamics and social relations, among other things (excellent goals, surely); the two validated treatments mentioned seek to remove symptoms of PTSD, and thus fully resolve the diagnosis. Which would you choose, as an outcome? Both are good, but one is strikingly better.

TomCloyd (talk) 20:53, 28 December 2009 (UTC)