Jones Edgar, Wessely Simon
Institute of Psychiatry and King's Centre for Military Health Research, Weston Education Centre, 10 Cutcombe Street, London SE5 9RJ, United Kingdom.
J Anxiety Disord. 2007;21(2):164-75. doi: 10.1016/j.janxdis.2006.09.009. Epub 2006 Oct 24.
The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm shift in the conceptualisation of post-trauma illness. Hitherto, a normal psychological reaction to a terrifying event was considered short-term and reversible. Long-term effects, characterized as "traumatic neurosis", were regarded as abnormal. Enduring symptoms were explained in terms of hereditary predisposition, early maladaptive experiences or a pre-existing psychiatric disorder. The event served merely as a trigger to something that existed or was waiting to emerge. Secondary gain, the benefits often but not solely financial that a person derived as a result of being ill, was considered the principal cause of any observed failure to recover. The recognition of PTSD reflected a diversion from the role of the group, in particular the "herd instinct", towards a greater appreciation of the individual's experience. From being the responsibility of the subject, traumatic illness became an external imposition and possibly a universal response to a terrifying and unexpected event. This shift from predisposition to the characteristics of the event itself reduced guilt and blame, while the undermining of secondary gain made it easier to award financial compensation.
1980年创伤后应激障碍（PTSD）被纳入《精神疾病诊断与统计手册》第三版（DSM - III），这标志着创伤后疾病概念化的范式转变。在此之前，对可怕事件的正常心理反应被认为是短期且可逆的。长期影响，被称为“创伤性神经症”，则被视为异常。持久症状被解释为遗传易感性、早期适应不良经历或先前存在的精神疾病。该事件仅仅作为引发已存在或即将出现问题的触发因素。继发获益，即一个人患病后通常但不限于经济方面所获得的益处，被认为是观察到的康复失败的主要原因。对PTSD的认识反映了从群体作用，特别是“群体本能”的角度，转向对个体经历的更多关注。创伤性疾病从主体的责任变成了一种外部强加，并且可能是对可怕且意外事件的普遍反应。这种从易感性到事件本身特征的转变减少了内疚和指责，同时削弱继发获益使得给予经济补偿变得更容易。
