Over the years my wife, and fellow therapist, Alicia Fortinberry, and I have treated many people who were suffering from what is called post traumatic stress disorder or PTSD including a number of Vietnam veterans. In talking to the vets I noticed that a pattern was developing which caused me to widen my enquiries to veterans who went through the same experiences in Asia, but who did not have the symptoms of PTSD.

I have not had the time to do a formal study, but I have come to some very interesting conclusions regarding the disorder, which have been confirmed by some recent studies. I have become convinced of the strong link between PTSD and depression and between both of those and childhood trauma.

The Origins of PTSD

I have long been interested in the effect of childhood trauma in the development of a number of mood disorders such as depression and dysthemia (a milder form of on-going depression). I believe that depression childhood can be a form of dissociative disorder — a way the child escapes the harsh reality of his or her environment through a slowing down of mental activity. Almost all patients that I have seen who were depressed when they were children were the victims of some sort of abuse: physical, sexual or verbal in the form of criticism or implied threats of violence or abandonment. I am not saying that all depression is the result of childhood trauma or that all children who were abused become clinically depressed, just that in many children there seems to be a causal relationship between early abuse and depression.

In dealing with the vets I found the same sort of relationship -- those who were diagnosed with PTSD tended to have traumatic childhoods and those who were free of PTSD did not.

What is PTSD? Although traumatic events have long been known to cause psychological problems, the disorder itself was first formally characterized in the early 1980s. Even now it is the subject of controversy, with many psychiatrists and clinical psychologists saying a diagnosis of PTSD is meaningless (see articles in recent editions of the British Medical Journal). Personally I do not subscribe to this view, rather I believe the problem is one of inaccurate diagnosis.

Generally speaking PTSD is identified by the following three symptoms: 1) re-experiencing traumatic events (ie, obsessive recollections, flashbacks, nightmares); 2) avoidant symptoms (fear of being with people); and 3) signs of hyperarousal (easily startled, irritable). Traumatized people often suffer from a combination of PTSD, depression and other anxiety disorders.

Often the victims of PTSD are mis-diagnosed. For example, some patients will present more severe symptoms of hyperarousal with severe depression. The re-experiencing of events is often mis-diagnosed as "obsessiveness" within a depressive disorder. Hyperarousal symptoms may be mis-diagnosed as insomnia and anxiety within a major depressive episode. Other PTSD victims are mis-diagnosed with obsessive-compulsive disorder.