Post traumatic stress disorder (PTSD) is the only diagnosis that places the origin of the symptoms on external events, rather than on the individual personality. The PTSD diagnosis is also the only one that recognizes that subject to enough stress, any human being has the potential for developing PTSD or PTSD symptoms. What this means is that although individuals may have a pre-trauma personality, belief system, and set of values which certainly can affect their reactions to an interpretation of a traumatic event, they would not develop PTSD because of some inherent inferiority or weakness in their personality. In other words, trauma changes personalities, not the other way around. 

According to the official definition of PTSD in DSM-IV (Diagnostic Statistical Manual of the American Psychiatric Association), to qualify for the diagnosis of PTSD, you must meet the following criteria:

1. You must have been exposed to a traumatic event involving actual or threatened death or injury during which you respond with panic, horror, or feelings of helplessness.
2. You re-experience the trauma in the form of dreams, flashbacks, intrusive memories, or unrest at being at situations that remind you of the original trauma. 
3. You show evidence of avoidance behavior - a numbing of emotions and reduced interest in others and the outside world.
4. You experience physiological hyper-arousal as evidenced by insomnia, agitation, irritability, or outbursts of rage. 
5. The symptoms in criteria 2, 3, and 4, persist for at least one month
6. The symptoms have significantly affected your social or vocational abilities or other important areas of your life.

PTSD can be either an acute or delayed onset. Acute PTSD occurs within six months after a traumatic event. In delayed onset PTSD, the symptoms occur anytime later than 6 months after the traumatic event. This can be one year, twenty years, or even forty years after the traumatic event. For example, a previously asymptomatic sixty year old individual can develop PTSD in response to having been sexually or physically abused as a child. 

Although the diagnosis of post traumatic stress disorder was introduced into the diagnostic system in 1980, there have been consistent patterns of psychological distress following sudden traumatic experiences, such as natural disasters, or combat, which has been described in both professional and popular literature for many years prior to the current description of post traumatic stress disorder in the Diagnostic Statistical Manual of the American Psychiatric Association. Under different names, historians, poets, and doctors, as far back as the days of the ancient Greeks, have documented PTSD. PTSD has been with us for many years, and has been known under many different names, but the impact has remained consistent. DSM-IV provides the following definition of trauma:

“direct personal experience of an event that involves actual, or threatened death or serious injury, or other threat to one’s physical integrity; witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm or threat of death or injury experienced by a family member or other close associate.” 

 The person’s response to the event must involve intense fear, helplessness, or horror. The DSM-IV also provides a non-exhaustive list of typical stressors, including combat, sexual and physical assault, robbery, being kidnapped, being taken hostage, terrorist attack, torture, disasters, severe automobile accidents and life-threatening illnesses, as well as witnessing death or serious injury by violent assault, accidents, war, or disaster. Also included is childhood sexual abuse, even if it does not involve threatened or actual violence or injury.

“No man is an island.” How true this statement is when you examine how PTSD affects not only the trauma victim but also those who live with him or her. The symptoms that surround the trauma survivor can spill over to touch the spouse and children as well. For example, a Vietnam veteran who alternates between states of numbing and hyper arousal can play havoc with his marriage and children. His wife tries to cope with his flashbacks, anxiety attacks, and intrusive thoughts during the day as well as nightmares and thrashing about at night. Several wives have expressed their own fear of being hit or choked when their spouses have attacked them during a nightmare or night terror. According to Matsahis (1996), the symptoms of PTSD are retraumatizing in themselves… survivors have difficulty in being present to others. On the other hand, in response, others can feel rejected and move away from the trauma victim deciding he or she is impossible, argumentative, or just crazy.

Children watch their parents deal with everyday challenges. This is how they learn. If they are observing a parent coping with trauma, they often see dysfunctional behavior. Since parents are natural teachers and are usually looked up to by their children, you can easily figure out that the children of survivors may take on abnormal views and behaviors as a result of modeling their parents’ behavior. For example, trauma survivors often try to cope with PTSD symptoms through addiction. Drug and alcohol dependence are the most common. However, excessive behavior, such as food intake, sexual promiscuity, or gambling can also develop. The impact upon the spouse as well as the children in a family where a trauma survivor utilizes substance abuse as a form of self-medication can be devastating. Not only is it difficult to deal with a family trauma survivor with an addiction problem, but the modeling impact is even greater. If mom or dad can use marijuana or cocaine to deal with life, why can’t I?

The intergenerational effects of PTSD can invade many future generations. How many of my own Vietnam veteran clients admit that not only did they suffer firsthand trauma from combat but had secondary PTSD from living with their fathers who fought in World War II. They relate that their fathers were distant, militaristic in their parenting style, and showed little or no emotion toward them or their siblings.

There are many issues related to intergenerational effects of PTSD, too numerous to discuss in this article. However, this writer wishes to make readers aware of this concept. With increased awareness, hopefully individuals will seek therapy for their wounded families and themselves.