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Causality and PsychopathologyFinding the Determinants of Disorders and their Cures$
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Patrick Shrout, Katherine Keyes, and Katherine Ornstein

Print publication date: 2011

Print ISBN-13: 9780199754649

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199754649.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 08 December 2021

Causes of Posttraumatic Stress Disorder

Causes of Posttraumatic Stress Disorder

12 (p.297) Causes of Posttraumatic Stress Disorder
Causality and Psychopathology

Naomi Breslau

Oxford University Press

The definition of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), and in subsequent DSM editions is based on a conceptual model that brackets traumatic events from other stressful experiences and PTSD from other responses to stress and links the two causally. The connection between traumatic experiences and a specific mental disorder has become part of the general discourse. PTSD provides a cultural template of the human response to war, violence, disaster, or very bad personal experiences. The DSM-III revolutionized American psychiatry. The manual’s editors wanted a symptom-based, descriptive classification and generally rejected any reference to causal theories about mental processes. PTSD was an exception to the rule of creating a classification that is ‘‘atheoretical with regard to etiology or pathophysiological process’’ (American Psychiatric Association, 1980 p. 7), but the exception was not noted anywhere in the manual. Not only did the PTSD definition include an etiological event, but it incorporated a theory, an underlying process, that connects the syndrome’s diagnostic features (McNally, 2003; Young, 1995). In 1994, the American Psychiatric Association published the fourth edition of the DSM. The definition of PTSD, which had already undergone some revisions in DSM-IIIR, maintained the syndrome’s description but changed materially the stressor criterion. The range of events was widened, and the emphasis shifted to the subjective experience of victims. The list of ‘‘typical’’ traumas in the DSM-IV left no doubt that the intent was to enlarge the variety of experiences that can be used to diagnose PTSD beyond the initial conception of directly experienced, life-threatening events such as combat, natural disaster, rape, and other assault. Persons who learned about a threat to the physical integrity of another person or about a traumatic event experienced by a friend could be considered victims. A novel form of PTSD took shape following the 9/11 terrorist attacks, when the entire population of the United States was considered to have been affected by a ‘‘distant’’ trauma, produced chiefly by viewing television coverage.

Keywords:   Conditional probability, Major depression, Natural response, Peritraumatic responses

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