"It is widely recognized that soldiers suffer psychologic consequences of combat (Jones 2006). The constellation of symptoms that has come to be known as PTSD was given other names in earlier wars. During the Civil War, "irritable heart" or "effort syndrome" featured shortness of breath, disturbed sleep, palpitations, and other symptoms. During World War I, effort syndrome was again diagnosed, as was "shell shock," which was first described in British soldiers evacuated from the trenches in France. Marked by blindness, muteness, and amnesia, shell shock was initially thought to be the result of brain concussion from nearby shell explosions, but over time it became clear that effort syndrome and shell shock had psychologic origins (Hyams et al. 1996; Shephard 2001). During World War II, physicians identified an acute psychologic syndrome commonly found in soldiers, which they referred to as battle fatigue or combat exhaustion, so named to avoid stigma and to imply that soldiers would recover naturally with food and rest. Although the sheer number of psychiatric casualties was high, many of the troops were returned to combat after treatment near the front line (Grob 1994; Shephard 2001). Nevertheless, in 1942-1945, 850,000 active-duty U.S. soldiers were admitted to military hospitals for neuropsychiatric care (Starr 1982). A persistent and chronic form of battle fatigue was described among those veterans (Friedman et al. 1994; Grob 1994; Southwick et al. 1994). In World War II, Grinker and Spiegel (1945) described cases of "war neurosis" in members of combat aircrews. The primary symptoms of war neurosis were restlessness, irritability, aggression, fatigue, sleep difficulties, anxiety, startle reaction, tension, depression, personality changes, memory disturbances, tremors, difficulty in concentrating, alcoholism, preoccupation with combat experiences, decrease in appetite, psychosomatic symptoms, irrational fears, and suspiciousness.
The experiences of World War II military psychiatrists were instrumental in spurring the profession into the modern era of psychiatric diagnosis. Military psychiatrists believed that psychiatric disorders among veterans of military combat were more pervasive and serious than had been anticipated before the war. They also believed, contrary to prevailing views, that psychological maladjustment could be triggered by external stress (Grob 1994). Their influence was felt in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1952 by the American Psychiatric Association (APA).
After the Vietnam War, research demonstrated that many veterans, particularly those exposed to severe war-related trauma, and other traumatized populations such as Holocaust survivors, suffered from chronic psychologic problems that often resulted in social and occupational dysfunction. The strength of the evidence led to the formal recognition of PTSD as a psychiatric diagnosis in the third edition of DSM (DSM-III), published in 1980....."
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