The History of Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a widely recognized mental health condition today, but its roots trace back centuries through various forms and understandings. Across history, symptoms now associated with PTSD were often misunderstood or attributed to physical or moral weakness. From ancient times to modern-day psychiatry, science and society have shaped the recognition and treatment of PTSD.

Early Accounts of Trauma in Ancient and Classical History

While PTSD as a formal diagnosis is common in modern times, accounts of trauma-related symptoms appear in some of mankind’s earliest historical records. Ancient medical texts from various cultures often describe symptoms like disturbed sleep and fear responses following traumatic battle events. The symptoms are remarkably similar to how post-traumatic stress symptoms are defined today ^[1].

During the Assyrian Dynasty (1300–609 BC), the people of Mesopotamia (modern-day Iraq) were the first to develop writing. Many of their records have survived, particularly in the form of clay medical tablets that reference soldiers, who were called upon to fight every third year of their military service, developing symptoms of trauma after battle ^[2].

Some of the most common post-battle trauma reactions found in ancient Mesopotamian texts include recurring nightmares, excessive drinking, emotional detachment from others, flashbacks to previous battles, and violent outbursts. They also made note of warriors experiencing difficulty sleeping and avoiding reminders of their trauma ^[2].

Although early writers did not frame these accounts as mental illness, they offered evidence that humans have long grappled with the psychological aftermath of trauma.

17th to 19th Centuries Bring New Types of Trauma

Writers and physicians in the 17th and 18th centuries began to describe symptoms resembling PTSD more systematically. The term “nostalgia” was used to explain emotional disturbances in soldiers far from home, thought to be a form of homesickness. Physicians observed sadness, sleep disruption, and anxiety, but considered them temporary or even cowardly ^[3]. By the 19th century, as industrial technology advanced, people began experiencing unfamiliar injuries and stress reactions. Some individuals involved in train accidents developed lasting symptoms that puzzled doctors, who weren’t sure whether the cause was physical damage or a psychological response to the traumatic event.

Important developments during this time include:

• Recognition of trauma in civilians, not just soldiers
• Emergence of psychological theories for unexplained physical symptoms
• Rise of the concept of “hysteria” and its connection to trauma, especially in women
• Use of hypnosis to explore traumatic memory
• Growing tension between neurological and psychological explanations

These debates laid the groundwork for a new understanding that trauma-related disorders are complex and multifactorial, which reinforced the importance of obtaining fundamental information on PTSD.

World Wars I and II Bring New Terminology

During World War I, many soldiers began exhibiting severe psychological symptoms despite the absence of visible injuries. At the time, these symptoms were thought to be caused by physical trauma from nearby explosions, leading to the term “shell shock ^[4].” However, as it became clear that many affected individuals had not experienced direct blasts, the medical field had to reconsider its assumptions and acknowledge psychological trauma as a potential cause of dysfunction. 

By World War II, the term “battle fatigue” emerged, reflecting a shift in thinking toward stress-related origins. This period marked a turning point in the evolving conceptual framework of trauma, as military psychiatry began actively addressing these conditions through early screening and intervention programs. These developments played a key role in shaping how PTSD would later be understood, not simply as a response to external stressors, but as a complex disorder with psychological, social, and biological dimensions ^[5].

Common symptoms seen in combat veterans included:

• Sudden panic in response to loud noises
• Withdrawal and emotional flatness
• Insomnia and disturbing dreams
• Startle responses and hypervigilance
• Loss of motivation or purpose

This era marked a critical turning point, emphasizing the need for formal recognition and structured support for trauma-related disorders. 

Post-War Period and the Vietnam Generation

Following World War II, psychiatry began to consider trauma as part of a broader range of mental health conditions. However, it wasn’t until the Vietnam War that momentum grew for a distinct diagnostic category. Unlike earlier conflicts, the Vietnam War lost public support and became politically divisive. Many veterans felt alienated and unsupported, which worsened their psychological problems. Veterans’ mental health professionals began to push for the recognition of PTSD as a unique disorder resulting from trauma, especially as more veterans from the Vietnam War exhibited its symptoms ^[6].

With a clear understanding of PTSD prevalence rates, pivotal moments from this era helped to shape modern treatment and prevention strategies. Impactful contributions included:

• In-depth clinical studies of returning soldiers
• Formation of veteran-led advocacy organizations
• Inclusion of trauma narratives in psychological literature
• Exploration of childhood and interpersonal trauma as contributors
• Calls to differentiate trauma-based symptoms from other anxiety disorders

This wave of understanding and advocacy directly influenced the inclusion of PTSD in diagnostic manuals.

Formal DSM Recognition and Evolving Definitions

The American Psychiatric Association officially recognized PTSD in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), a pivotal moment that set the stage for the development of PTSD as a formal diagnosis. Since then, the definition of PTSD has evolved significantly, with the DSM-5 representing the most recent and comprehensive revision. This edition expanded the criteria to include a wider array of symptoms, including dissociation and negative mood changes. It broadened the understanding of trauma to encompass various types, such as childhood abuse, sexual assault, and natural disasters ^[7].

Key changes in diagnostic criteria over time include:

• Reorganization of symptom clusters (intrusion, avoidance, arousal)
• Inclusion of indirect trauma exposure (e.g., first responders)
• Recognition of the delayed onset of symptoms
• Consideration of cultural context in diagnosis
• Expansion to include complex and chronic trauma

As understanding of PTSD grew, so did the need for nuanced diagnoses and individualized treatment approaches.

Contemporary Understanding and Public Awareness

Today, PTSD is widely recognized across clinical, social, and political spheres. Increased awareness has led to more funding for research, better diagnostic tools, and improved access to care. The modern understanding of PTSD recognizes that trauma can arise from many sources and affect diverse populations ^[7]. It also emphasizes long-term effects and the duration of PTSD. 

Public education campaigns, media coverage, and advocacy by survivors have all contributed to reducing stigma. Clinicians now use evidence-based treatments such as cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and pharmacological interventions ^[6].

Current priorities in PTSD care include:

• Identifying early interventions for high-risk individuals
• Personalizing treatment plans based on trauma type and history
• Understanding the neurobiology of trauma
• Integrating trauma-informed practices into healthcare systems
• Addressing disparities in access and outcomes

A Long Road to Recognizing PTSD

The history of PTSD reveals the slow but significant public and medical shift from dismissal to understanding. What began as scattered observations across ancient texts evolved into a clearly defined mental health diagnosis with global recognition. Scientific advances, wartime experiences, and persistent advocacy have all contributed to the progress. 

While challenges remain in terms of treatment and fighting stigma, continued efforts are improving outcomes for those affected by trauma.