Post Traumatic Stress Disorder (PTSD) 1993-4

(adapted from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]):
The person has undergone an event which involved a threat to physical integrity and has responded with horror or helplessness. For more than a month, the event is persistently re-experienced by recollections, dreams, reliving, or by intense distress or physiological reaction to reminders of the trauma (cues). There is persistent avoidance of cues; diminished interest, intimacy, range of emotions, recall of event details; a sense of a foreshortened future. Arousal is increased - sleep disturbance, irritability/anger, lack of concentration, hypervigilance, readily startled. There is significant distress or impaired functioning, particularly social or occupational.

Blood-pressure, heart-rate, intensity of blinking, skin-conductivity and muscle electrical activity could add some objectivity to what are otherwise subjective criteria[1]. The admissibility of such evidence was untested at the time of writing (1993).

10% of MVA victims with multiple injuries or whiplash developed posttraumatic stress disorder[2]. Sufferers characteristically had horrific memories, did not have a neurotic predisposition. Mental state at a year could be predicted at three months.

A minority of patients with PTSD flashbacks appear to be suffering from a form of temporal lobe epilepsy[3], as suggested by electroencephalographic (EEG) patterns and dramatic response to antiepileptic medication.

The same authors desensitised the nonepileptics in a novel way - they made an audiotape of a session in which the patient relived the traumatic event, then had the patient replay it repeatedly until it became boring.

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