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Long-Term Trajectories and Recovery from PTSD



This chapter presents theoretical formulations, clinical nosology, and empirical studies of the longitudinal course, trajectories, and recovery associated with post-traumatic stress disorder (PTSD) as induced by combat. We focus on systematic, empirical, long-term prospective studies, with particular attention to two Israeli longitudinal studies.

Traumatic stress is highly pathogenic, and its effects take many forms. Although PTSD has been a major focus of post-trauma psychiatric research, there is considerable variability in human responses to trauma. Whereas many people are able to put the trauma behind them and resume their lives, others may respond with stress reactions at various levels of severity. In some cases, the experience does indeed lead to acute or even chronic PTSD.

High rates of PTSD decades after war indicate that war trauma is profound and enduring, causing considerable suffering and impairment. Studies demonstrate the complex nature and temporal dynamics of traumatic responses, including the fluctuating course of PTSD that gives rise to various PTSD subtypes. A steep increase in rates of PTSD, even decades postwar, demonstrates that war and captivity trauma can leave individuals vulnerable throughout the life span, even though they may express early resilience.

We conclude that PTSD is a chronic disorder that entails severe distress and impairment even among individuals who do not initially demonstrate symptoms or whose symptoms remit. We propose that PTSD should be conceptualized as an autoimmune mental disorder, whereby the individual’s subsequent defensive response is outsized with respect to relatively innocuous stimuli. Appropriate treatment and policy modalities are needed to alleviate both human suffering and the considerable economic toll.

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