|Posttraumatic stress disorder|
Classification and external resources
Post traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Anxiety disorder is a blanket term covering several different forms of abnormal pathological anxieties Fears and Phobias In clinical usage "fear"  It is a severe and ongoing emotional reaction to an extreme psychological trauma. Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event.  This stressor may involve someone's actual death or a threat to the patient's or someone else's life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping. The psychological definition of coping is the process of managing taxing circumstances expending effort to solve personal and interpersonal problems and seeking In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined.
PTSD is a condition distinct from traumatic stress, which is of less intensity and duration, and combat stress reaction, which is transitory. Traumatic stress is recognized by the Diagnostic and Statistical Manual of Mental Disorders as an acute Emotional condition associated with reactive Anxiety PTSD has also been recognized in the past as shell shock, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).
PTSD is believed to be caused by psychological trauma. Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event.  Possible sources of trauma includes experiencing or witnessing childhood or adult physical, emotional or sexual abuse. Physical abuse is abuse involving contact intended to cause feelings of intimidation Pain, Injury, or other physical Suffering or Harm. Psychological abuse or emotional abuse is a form of abuse characterized by a person subjecting or exposing another to behavior that is psychologically harmful Sexual abuse, also referred to as molestation, is the forcing of undesired sexual acts by one person upon another  In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or the experience of, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers). Assault is a Crime of Violence against another person. In some Jurisdictions including Australia and New Zealand, Sexual assault is any Assault of a sexual nature on another person Drug addiction is widely considered a pathological state. The disorder of addiction involves the progression of acute Drug use to the development of drug-seeking Illness (sometimes referred to as ill-health or ail) can be defined as a state of poor Health. Complication, in Medicine, is an unfavorable evolution of a Disease, a Health condition or a medical treatment War is an international relations Dispute, characterized by organized Violence between National Military units A soldier is a general English term that refers to a member of a land component of National Armed forces. Emergency services are organizations which ensure Public safety by addressing different emergencies Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, bad car accidents or getting a diagnosis of a life-threatening illness.  Children may develop PTSD symptoms by experiencing sexually traumatic events like age inappropriate sexual experiences.  Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms.  The amount of dissociation that follows directly after a trauma predicts PTSD.  Individuals that are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.  Many servicemen and women coming back from Iraq and Afghanistan have PTSD.  The diagnosed cases of PTSD in United States troops sent to either Afghanistan or Iraq went up 46. 4 percent in 2007. This brought the total over five years to almost 40,000 (from U. S. military data).  The Marines and the Army are much more likely to have it than the Air Force and Navy, because of their greater percentage of exposure to combat.  In a preliminary study, it has been shown that mutations in a stress-related gene interact with child abuse to increase the risk of PTSD in adults. 
PTSD displays biochemical changes in the brain and body that differ from other psychiatric disorders such as major depression. Biochemistry is the study of the chemical processes in living Organisms It deals with the Structure and function of cellular components such as Individuals diagnosed with PTSD respond more strongly to a dexamethasone suppression test than individuals diagnosed with clinical depression. The dexamethasone suppression test is designed to diagnose and differentiate among the various types of Cushing's syndrome and other hypercortisol states Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression In addition, most PTSD also show a low secretion of cortisol and high secretion of catecholamine in urine and the norepinephrine/cortisol ratio is consequently higher than comparable non-diagnosed individuals. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a This is in contrast to the normative fight-or-flight response, in which both catecholamine and cortisol levels are elevated after exposure to a stressor. The fight-or-flight response', also called the fright, fight or flight response, hyperarousal or the acute stress response, was first Brain catecholamine levels are low, and corticotropin-releasing factor (CRF) concentrations are high. Corticotropin-releasing hormone ( CRH) originally named corticotropin-releasing factor ( CRF) and also called corticoliberin, is a Polypeptide Together, these findings suggest abnormality in the hypothalamic-pituitary-adrenal axis (HPA). The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences Given the strong cortisol suppression to dexamethasone in PTSD, HPA axis abnormalities are likely predicated on strong negative feedback inhibition of cortisol, itself likely due to an increased sensitivity of glucocorticoid receptors. Dexamethasone is a potent synthetic member of the glucocorticoid class of Steroid Hormones It acts as an Anti-inflammatory and immunosuppressant The glucocorticoid receptor ( GR, or GCR also known as NR3C1 ( Nuclear receptor subfamily 3 group C member 1 is a Ligand -activated Transcription  Some researchers have associated the response to stress in PTSD with long-term exposure to high levels of norepinephrine and low levels of cortisol, a pattern associated with improved learning in animals. Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a In the fields of Neuropsychology, Personal development and Education, Learning is one of the most important Mental function of humans Translating this reaction to human conditions gives a pathophysiological explanation for PTSD by a maladaptive learning pathway to fear response through a hypersensitive, hyperreactive and hyperresponsive HPA axis. 
Low cortisol levels may predispose individuals to PTSD; following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels. "Sverige" redirects here For other uses see Sweden (disambiguation and Sverige (disambiguation. Bosnia and Herzegovina ( Latin script: Bosna i Hercegovina, Cyrillic script: Босна и Херцеговина is a country on the Balkan  Because cortisol is normally important in restoring homeostasis after the stress response, it is thought that trauma survivors with low cortisol experience a poorly contained—that is, longer and more distressing—response, setting the stage for PTSD. Homeostasis (from Greek: ὅμος hómos, "equal" and ιστημι istēmi, "to stand" lit However, there is considerable controversy within the medical community regarding the neurobiology of PTSD and a review of existing studies on this subject showed no clear relation between cortisol levels and PTSD. Only a slight majority have found a decrease in cortisol levels while others have found no effect or even an increase. 
In addition to biochemical changes, PTSD also involves changes in brain morphology. Combat veterans of the Vietnam war with PTSD showed an 8% reduction in the volume of their hippocampus in comparison with veterans who suffered no such symptoms. The hippocampus is a part of the Forebrain, located in the medial Temporal lobe.
In animal research as well as human studies, the amygdala has been shown to be strongly involved in the formation of emotional memories, especially fear-related memories. Animal testing or animal research is the use of non-human Animals in scientific experimentation. Neuroimaging studies in humans have revealed both morphological and functional aspects of PTSD. Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain The amygdalocentric model of PTSD proposes that it is associated with hyperarousal of the amygdala and insufficient top-down control by the medial prefrontal cortex and the hippocampus. The hippocampus is a part of the Forebrain, located in the medial Temporal lobe. Further animal and clinical research into the amygdala and fear conditioning may suggest additional treatments for the condition. Fear conditioning is the method by which organisms learn to fear new stimuli
PTSD runs in families: For twin pairs exposed to combat in Vietnam, having a monozygotic (identical) twin with PTSD was associated with an increased risk of the co-twin having PTSD compared to twins that were dizygotic (non-identical twins).  Because of the difficulty in performing genetic studies on a condition with a major environmental factor (ie. , trauma), genetic studies of PTSD are in their infancy. A functional polymorphism in the monoamine oxidase A (MAOA) gene promoter can moderate the association between early life trauma and increased risk for violence and antisocial behavior. Low MAOA activity is a significant risk factor for aggressive and antisocial behavior in adults who have been victimized as children. Persons, who were abused as children but have a genotype conferring high levels of MAOA expression are less likely to develop antisocial symptoms. This findings help explain why not all persons, who have experienced early childhood trauma victimize others. 
Schnurr, Lunney, and Sengupta identified risk factors for the development of PTSD in Vietnam veterans. Among those are:
They also identified certain protective factors, such as:
See also: Psychological resilience
The diagnostic criteria for PTSD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as:
Notably, criterion A (the "stressor") consists of two parts, both of which must apply for a diagnosis of PTSD. The first (A1) requires that "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. " The second (A2) requires that "the person’s response involved intense fear, helplessness, or horror. " The DSM-IV-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience. " Since the introduction of DSM-IV, the number of possible PTSD traumas has increased and one study suggests that the increase is around 50%. 
Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support.  Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. Cognitive Therapy (CT is a type of Psychotherapy developed by American Psychiatrist Aaron T Social stigma is severe social disapproval of personal characteristics or Beliefs that are against cultural norms.  The psychotherapy programs with the strongest demonstrated efficacy are all cognitive behavioral programs and include variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and combinations of these procedures. Exposure therapy is a Cognitive behavioral therapy technique for reducing fear and anxiety responses especially Phobia, based on the principles of Habituation  Exposure involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders.
Early intervention after a traumatic incident, known as Critical Incident Stress Management (CISM) is often used to reduce traumatic effects of an incident, and potentially prevent a full-blown occurrence of PTSD. Critical Incident Stress Management is an adaptive short term helping process that focuses solely on an immediate and identifiable problem to enable the individual(s affected to return However recent studies regarding CISM seem to indicate iatrogenic effects. The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice  Six studies have formally looked at the effect of CISM, four finding that although patients and providers thought it was helpful, there was no benefit for preventing PTSD. Two other studies have indicated that CISM actually made things worse. Some benefit was found from being connected early to cognitive behavioral therapy, or for some medications such as propranolol. Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. Effects of all these prevention strategies was modest. 
Eye Movement Desensitization and Reprocessing (EMDR) is specifically targeted as a treatment for PTSD. Eye Movement Desensitization and Reprocessing ( EMDR) is a form of psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences  Research on EMDR is largely supported by those with the copyright for EMDR and third-party studies of its effectiveness are lacking, but a meta-analytic comparison of EMDR and cognitive behavioral therapy found both protocols indistinguishable in terms of effectiveness in treating PTSD. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations 
Standard medication therapy useful in treating PTSD include SSRIs (selective serotonin reuptake inhibitors) and TCAs (tricyclic antidepressants). SSRIs for which there is data to support their use are: citalopram, escitalopram, fluvoxamine, paroxetine and sertraline 
There is data to support the use of "autonomic medicines" such Propranolol and Clonidine ( beta blocker) if there are significant symptoms of "over-arousal". Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias These may inhibit the formation of traumatic memories by blocking adrenaline's effects on the amygdala, has been used in an attempt to reduce the impact of traumatic events. The la amygdalae ( Latin, also la corpus amygdaloideum, singular la amygdala, from Greek el αμυγδαλή grc-Latn amygdalē, 'almond'  or they may simply demonstrate to the patient that the symptoms can be controlled thereby assisting with "self efficacy" and helping the patient remain calmer. There is also data to support the use of mood-stabilizers such lithium carbonate, divalproex sodium and carbemazepine if there is significant uncontrolled mood or aggression. Risperidone is used to help with dissociation, mood and aggression, and benzodiazepines are used for short-term anxiety relief. 
PTSD is commonly treated using a combination of psychotherapy (cognitive-behavioral therapy, group therapy, and exposure therapy are popular) and medications such as antidepressants (i. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations Group psychotherapy is a form of Psychotherapy in which one or more therapists treat a small group of clients together as a group Exposure therapy is a Cognitive behavioral therapy technique for reducing fear and anxiety responses especially Phobia, based on the principles of Habituation An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression e. SSRI's such as fluoxetine and sertraline, SNRI's such as venlafaxine, NaSSA's such as mirtazapine and tricyclic antidepressant such as amitriptyline) or atypical antipsychotic drugs (such as quetiapine and olanzapine). Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Serotonin-norepinephrine reuptake inhibitors (SNRIs are a class of Antidepressant used in the treatment of major depression and other mood disorders Venlafaxine (Effexor Efexor is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor (SNRI class first introduced by Wyeth in 1993 Noradrenergic and selective serotonergic antidepressants (abbreviated NaSSAs) are a relatively new class of Antidepressants They are thought to work by blocking presynaptic Mirtazapine is an Antidepressant introduced by Organon International in 1994 used for the treatment of moderate to severe depression. Tricyclic antidepressants (abbreviation TCAs) are a class of Antidepressant drugs first used in the 1950s Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil Tryptanol Endep Elatrol Tryptizol Trepiline Laroxyl Saroten is a Tricyclic antidepressant The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions Quetiapine ( kwe-TYE-a-peen marketed by AstraZeneca as Seroquel and by Orion Pharma as Ketipinor, is an Atypical antipsychotic Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is  Recently the anticonvulsant lamotrigine has been reported to be useful in treating some people with PTSD. The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic Lamotrigine (marketed as Lamictal (ləˈmɪktəl by GlaxoSmithKline, called Lamictin in South Africa, he למוג'ין ( Lamogine 
While MDMA had its first exposure to the psychiatric community in the 1960s, gaining a reputation for its communication enhancing qualities, it hasn't been until recent years that formal studies have been carried out. The US Food and Drug Administration (FDA) recently approved a clinical protocol that combines the drug MDMA with talk therapy sessions. MDMA ( 34-methylenedioxy- N -methylamphetamine) most commonly known today by the street name Ecstasy (often abbreviated E, X,  Funded by the non-profit Multidisciplinary Association for Psychedelic Research (MAPS), the studies are taking place in South Carolina under the supervision and direction of Dr. Michael Mithoefer. Other PTSD/MDMA research include a pilot study in Switzerland, co-sponsored by MAPS and the Swiss Medical Association for Psycholytic Therapy (SAePT), and another study approved in Israel to investigate MDMA as a tool in the psychotherapeutic treatment of crime and terrorism-related PTSD. 
There are several features of MDMA that make it an excellent candidate for treating PTSD in psychotherapy. The effects of MDMA are such that activity in the left amygdala, responsible for fear and anxiety, decreases in rats. The la amygdalae ( Latin, also la corpus amygdaloideum, singular la amygdala, from Greek el αμυγδαλή grc-Latn amygdalē, 'almond' This makes it a promising candidate as a tool in psychotherapy, allowing the patient to explore and examine their trauma (and accompanying emotions) without the fear and retraumatization encountered without drug. Ordinarily incapacitated by the resurgence of emotions(fear, shame, anger) attached to the trauma, subjects are rendered capable of approaching their trauma in a new and constructive way. Further helpful in treating PTSD, is the new capacity to experience empathy and compassion for both others and the self. 
Attachment- and relationship-based treatments are also often used. Attachment theory, originating in the work of John Bowlby, is a Psychological, evolutionary and ethological theory that provides a descriptive  In these cases, the treatment of complex trauma often requires a multi-modal approach. Yoga Nidra has been used to help soldiers cope with the symptoms of PTSD. Yoga Nidra, may be rendered in English as "yogic sleep" or "sleep of the yogis" 
PTSD may be experienced following any traumatic experience, or series of experiences that satisfy the criteria and that do not allow the victim to readily recuperate from the detrimental effects of stress. The National Comorbidity Survey Report provided the following information about PTSD in the general adult population: The estimated lifetime prevalence of PTSD among adult Americans is 7. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given 8%, with women (10. 4%) twice as likely as men (5%) to have PTSD at some point in their lives.
The National Vietnam Veterans' Readjustment Study (NVVRS) found 15. 2% of male and 8. 5 of female Vietnam Vets to suffer from current PTSD at the time of the study. Life-Time prevalence of PTSD was 30. 9 for males and 26. 9 for females. In a reanalysis of the NVVRS data, along with analysis of the data from the Matsunaga Vietnam Veterans Project, Schnurr, Lunney, Sengupta, and Waelde found that, contrary to the initial analysis of the NVVRS data, a large majority of Vietnam veterans suffered from PTSD-symptoms. Four out of five reported recent symptoms when interviewed 20-25 years after Vietnam. 
In recent history, catastrophes (by human means or not) such as the Indian Ocean Tsunami Disaster may have caused PTSD in many survivors and rescue workers. The 2004 Indian Ocean earthquake was an undersea Earthquake that occurred at 005853 UTC on December 26 2004 with an Epicentre off the west coast of Today relief workers from organizations such as the Red Cross and the Salvation Army provide counseling after major disasters as part of their standard procedures to curb severe cases of post-traumatic stress disorder. The International Red Cross and Red Crescent Movement is an International humanitarian movement with approximately 97 million volunteers worldwide who stated The Salvation Army is a Christian charity and church that is internally organised like a military service.
There is debate over the rates of PTSD found in populations, but despite changes in diagnosis and the criteria used to define PTSD between 1997 and 2007, epidemiological rates have not changed significantly. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the 
Reports of battle-associated stress appear as early as the 6th century BC.  Although PTSD-like symptoms have also been recognized in combat veterans of many military conflicts since, the modern understanding of PTSD dates from the 1970s, largely as a result of the problems that were still being experienced by Vietnam veterans. War is an international relations Dispute, characterized by organized Violence between National Military units 
The term post-traumatic stress disorder or PTSD was coined in the mid 1970s.  Early in 1978, the term was used in a working group finding presented to the Committee of Reactive Disorders.  The term was formally recognised in 1980.  (In the DSM-IV, which is considered authoritative, the spelling "posttraumatic stress disorder" is used. Elsewhere, "posttraumatic" is often rendered as two words — "post-traumatic stress disorder" or "post traumatic stress disorder" — especially in less formal writing on the subject. )
The diagnosis was removed from the DSM-II, which resulted in the inability of Vietnam veterans to receive benefits for this condition. In part through the efforts of anti Vietnam war activists and the anti war group Vietnam Veterans Against the War and Chaim F. Shatan, who worked with them and coined the term post-Vietnam Syndrome, the condition was added to the DSM-III as posttraumatic stress disorder. Vietnam Veterans Against the War ( VVAW) is a tax-exempt Non-profit organization and Corporation, originally created to oppose the Vietnam War Chaim F Shatan ( September 1, 1924 &ndash August 2001 was a Canadian Psychiatrist born in Włocławek, Poland. 
In the United States, the provision of compensation to veterans for PTSD is under review by the Department of Veterans Affairs (VA). The United States Department of Veterans Affairs ( VA) is a government-run military Veteran benefit system with Cabinet -level status The review was begun in 2005 after the VA had noted a 30% increase in PTSD claims in recent years. The VA undertook the review because of budget concerns and apparent inconsistencies in the awarding of compensation by different rating offices.
This led to a backlash from veterans'-rights groups, and to some highly-publicized suicides by veterans who feared losing their benefits, which in some cases constituted their only income. In response, on November 10, 2005, the Secretary of Veterans Affairs announced that "the Department of Veterans Affairs (VA) will not review the files of 72,000 veterans currently receiving disability compensation for post-traumatic stress disorder. Events 1444 - Battle of Varna: The crusading forces of King Vladislaus III of Varna (aka Ulaszlo I of Hungary and Wladyslaw Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. . . "
The diagnosis of PTSD has been a subject of some controversy due to uncertainties in objectively diagnosing PTSD in those who may have been exposed to trauma, and due to this diagnosis' association with some incidence of compensation-seeking behavior. Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. Incidence is a measure of the risk of developing some new condition within a specified period of time 
The social stigma of PTSD may result in under-representation of the disorder in military personnel, emergency service workers and in societies where the specific trauma-causing event is stigmatized (i. Social stigma is severe social disapproval of personal characteristics or Beliefs that are against cultural norms. A military is an Organization authorized by its Nation to use force usually including use of Weapons in defending its Country (or by attacking Emergency services are organizations which ensure Public safety by addressing different emergencies e. sexual assault). Sexual assault is any Assault of a sexual nature on another person 
Because of the United States soldiers in combat in the wars in Iraq and Afghanistan, soldiers returning home have faced significant physical, emotional and relational disruptions, the United States Marine Corps has instituted programs to assist Marines in re-adjusting to life, and in particular marriage, outside of the Marine Corps. The United States of America —commonly referred to as the The Iraq War, also known as the Second Gulf War, the Occupation of Iraq, or the War in Iraq, is an ongoing Military campaign The War in Afghanistan, which began on October 7 2001 as the U  Similarly, Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist servicemembers avoid or ameliorate PTSD and related problems. This article is about the US Army medical research institute (not the hospital Battlemind is both the mental orientation developed during a combat zone deployment and a program developed at Walter Reed Army Institute of Research (WRAIR intended to reduce
Veterans Affairs Canada is a new program including rehabilitation, financial benefits, job placement, health benefits program, disability awards and family support. The Department of Veterans Affairs ( DVA) also referred to as Veterans Affairs Canada ( VAC) is the department within the government 
Jonathan Shay, a psychiatrist for the Boston Department of Veterans' Affairs Outpatient Clinic was treating soldiers who suffered from PTSD. He was struck by the similarity of their war experiences to Homer's account of Achilles in the Iliad. "Achilleus" redirects here For the emperor with this name see Achilleus (emperor. The Iliad ( Greek: Ἰλιάς (Ancient Ιλιάδα (Modern is together with the Odyssey, one of two ancient He also believes Hotspur in William Shakespeares Henry IV, Part 1 is portrayed as a person suffering from PTSD J. R. R. Tolkien served in World War I. William Shakespeare ( baptised Henry IV Part 1 is a History play by William Shakespeare, believed to have been written no later than 1597 World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All It is believed that he portrayed Frodo Baggins in The Lord of the Rings as a person suffering from PTSD. The Lord of the Rings is an epic  In recent decades, with the concept of trauma, and PTSD in particular, becoming just as much a cultural phenomenon as a medical or legal one, artists have engage the issue in their work. Many movies, such as Birdy, Coming Home, The Deer Hunter, Born on the Fourth of July and Heaven & Earth deal with PTSD. Birdy is a 1984 film directed by Alan Parker and starring Matthew Modine and Nicolas Cage. Coming Home is a 1978 Drama film which tells the story of an injured Vietnam War veteran's difficulty in re-entering civilian life The Deer Hunter is a 1978 war Drama film about a trio of Rusyn American steel worker friends and their infantry service in the Born on the Fourth of July is a 1989 Film adaptation of the Autobiography of the same name by Vietnam War veteran Heaven & Earth is a 1993 film written and directed by Oliver Stone, and starring Tommy Lee Jones, Haing S It is an especially popular subject amongst "war veteran" films, often portraying Vietnam war veterans suffering from extreme PTSD and having difficulties adjusting to civilian life.
In more recent work, an example is that of Krzysztof Wodiczko who teaches at MIT and who is known for interviewing people and then projecting these interviews onto large public buildings. Krzysztof Wodiczko is an Artist currently living in Boston and teaching at MIT.  Wodiczko aims to bring trauma not merely into public discourse but to have it contest the presumed stability of cherished urban monuments. His work has brought to life issues such as homelessness, rape, and violence. Other artists who engage the issue of trauma are Everlyn Nicodemus of Tanzania and Milica Tomic of Serbia. 
George Carlin comments on the various incarnations of PTSD terminology on his 1990 album Parental Advisory: Explicit Lyrics. George Denis Patrick Carlin (May 12 1937 – June 22 2008 was an American stand-up comedian, often considered one of the best of all time Parental Advisory Explicit Lyrics is United States comedian George Carlin 's twelfth comedy album He traces the progression of what he views as euphemisms, which followed "shell shock" in World War I: "battle fatigue" in World War II, "operational exhaustion" in the Korean War, and finally PTSD, a clinical, hyphentated term, in the Vietnam War. A euphemism is a substitution of an agreeable or less offensive expression in place of one that may offend or suggest something unpleasant to the listener or in the case of doublespeak "The pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd have still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time. "