Post-traumatic stress disorder (PTSD) is not a new condition. Although it can occur in anyone who has been through a traumatic event, the disorder is by far most common among military veterans. PTSD has resulted from every combat-related conflict that has ever occurred. The disorder was given various names, such as “combat fatigue” and “shell shock.” It has only recently been recognized as a significant cause of morbidity and mortality. In 1980, the American Psychiatric Association (APA) added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme.
In the aftermath of the Vietnam war, the impact of PTSD became tragically clear. Among Vietnam veterans, the estimated prevalence of PTSD is more than 30%. In a study of Gulf War veterans conducted from 1995 to 1997, the incidence of PTSD was 12.1%. Among Operation Enduring Freedom/Operation Iraqi Freedom veterans, the reported rate of PTSD was 13.8%. However, figures from more recent years of conflict are considered to be significantly higher in actuality because of the known under-reporting of the condition.
Since 1980, increasing efforts have accurately identified patients with PTSD. Specific criteria were identified and then assessed by using a variety of scoring tools. In time, as the true epidemiologic burden of PTSD has become more understood, increasing emphasis has been placed on making these tools available in all areas of health care. Many patients with PTSD do not seek care from a mental health specialist, but they do see a primary care provider. Quick, evidence-based tools are now available for office-based use to improve the diagnosis and care coordination for these patients.