PTSD vs PTSI: What is the difference?
Marilyn J. Wooley, PhD
According to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), posttraumatic stress disorder (PTSD) is characterized by the development of certain symptoms following exposure to a traumatic event or events.
The experience of PTSD varies: some people mainly experience fear-based emotional and behavioral symptoms, while others enter dysphoric/depressive mood states. Some develop arousal and reactive-externalizing symptoms, while others primarily experience dissociative symptoms. Some develop a combination of these symptoms. Regardless of the exact symptoms—whether they be feelings of irritability, angry outbursts, issues with concentration and sleep, feelings of detachment from others, and nightmares of the event—what matters is they can cause problems in a person’s life.
In 1980, right after I completed my post-doctoral fellowship in California working with Vietnam veterans at the Long Beach Veterans Administration Hospital, the American Psychiatric Association (APA) formally and finally recognized PTSD as an actual mental health diagnosis, which at least eventually opened the door to treatment. Historically, it had been called “shell shock” and was thought only to occur in military war veterans. Most of my patients at the VA had symptoms of PTSD.
Historically, mental illness has been pathologized as something that is ‘wrong’ with the person, versus simply a manifestation of how most people would respond. My experience at the VA confirmed this view. Many of the doctors believed (in fact it was part of my training) that the constellation of posttraumatic stress symptoms occurred because the veterans had personality disorders before entering military service, or that they were malingering, alcoholic, or weak in some way. The consensus was that that they were mentally ill despite what had happened to them in Vietnam. Symptoms were minimized, and they were told to “get over it.” Our country’s shunning of the veterans upon their return home only reinforced this shameful view.
Fortunately, in recent years, people’s responses to overwhelming experiences have been systematically explored, and researchers have noted that trauma is stored in somatic memory and expressed as changes in the biological stress response. We now know PTSD affects the brain on a structural level, changing the way that the brain processes fear and triggering the fight or flight response. A division between the emotional and cognitive parts of the brain likely plays the dominant role in developing and maintaining PTSD. To summarize, PTSD is a biological trauma and researchers have observed physical changes in the nervous system that occur after trauma.
That brings to the difference between PTSD and PTSI. PTSD refers to a disorder, a mental illness if you will. Posttraumatic stress injury (PTSI) refers to a biological injury like a severed limb or a broken back. Philip Zimbardo (Zimbardo et al., 2012) argues that the symptoms are a natural reaction to a distressing event where the person may have felt overwhelmed, afraid, or helpless. They don’t stem from a mental illness, but from a mental injury. Removing the word ‘disorder’, and changing the name of PTSD to PTSI, could remove some barriers to seeking diagnosis and treatment. Certainly, it may have helped the Vietnam veterans gain the respect, understanding, and appropriate treatment they deserved.
Zimbardo, P., Sword, R., & Sword, R. (2012). The Time Cure: Overcoming PTSD with the New Psychology of Time Perspective Therapy. San Francisco, CA, US: Jossey-Bass.
