A proposed subtype of post traumatic stress disorder, combat trauma syndrome: wounds that don't bleed.

Abstract

This paper proposes a subtype, Combat Trauma Syndrome, to the diagnostic category of Post Traumatic Stress Disorder (PTSD) as included in the Diagnostic and Statistical Manual, Third Edition, 1980 (DSM III, 1980), by the American Psychiatric Association. Combat Trauma Syndrome is hypothesized to be a specific type of PTSD. This paper delineates the factors inherent to the acquisition of this particular subtype. The proposed Combat Trauma Syndrome incorporates components of Eriksonian, Existential, and Psychoanalytic concepts of ego and identity. These concepts of ego and identity are seen to be the foundation of Combat Trauma Syndrome subtype of PTSD. This paper addresses two specific levels of response to trauma and details the outcome of both. Concepts of guilt and shame are dealt with as the result of the behavioral response to the trauma of combat. The concept of layering of feelings and emotions is addressed as well as a new theoretical concept, Momentary Psychosis. The Momentary Psychosis concept is defined and differentiated from the Brief Reactive Psychosis, as defined and cited in DSM III, 1980. Implications for treatment of PTSD, Combat Trauma Syndrome, are provided. These include specific issues of grief and spirituality. Suggestions for research are also included in this paper. Five subtypes of PTSD are hypothesized for further clarification. Finally, four levels of anger are suggested and explanations of each are provided.