The international face of trauma is yet again in the news. As I sat down to write this editorial in late November 2008, the horrible tragedy in Mumbai was still unfolding. Hostages were being held and the death toll continued to rise. I could not help but wonder how many survivors, police, and other personnel would develop posttraumatic stress disorder (PTSD), hoping that the number would be low, but knowing that events such as this could lead to a high prevalence of posttraumatic problems.
In 1980, the American Psychiatric Association (APA) introduced the diagnosis of posttraumatic stress disorder into the Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III ). Posttraumatic stress disorder was included in the World Health Organization's International Classification of Mental and Behavioural Disorders (ICD-10) in 1992. The diagnostic criteria differ somewhat between the two classification systems, although the basic concept is the same-that of a distinctive, severe, and persistent reaction to an extreme stressor. The formalization of a diagnosis for such reactions has led to a remarkable body of research and greater understanding of the human response to stress-and the great capacity of individuals to cope with the unthinkable. The lives of individual trauma survivors have been improved as well, through better diagnosis and treatment.
Since the introduction of the PTSD diagnosis, the APA has revised the diagnostic criteria in successive editions of its manual, first in 1987 and then in 1994, and is again undertaking revisions. The new manual, DSM-V, is scheduled for completion in 2012. At this year's annual meeting of the International Society for Traumatic Stress Studies, (outgoing) President Stuart Turner organized an entire day of programming devoted to DSM-V. It was a noteworthy achievement. Katherine Phillips, Chair of the Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Workgroup for the revision process, presided over the day. The hours were filled with many stimulating presentations by investigators who found a way to communicate with each other, even when they held divergent views.