Post-traumatic stress disorder following military combat or peace keeping

Psychological or somatic dysfunction after military conflict may hide post-traumatic stress disorder

Trauma related to military service is not only physical. Since the American civil war it has been recognised that a proportion of veterans have symptoms but few physical signs.1 Conflicts and peacekeeping tours potentially carry long term psychiatric consequences. There is a strong concordance between symptoms after conflict regardless of the conflict.1 Histories of physical symptoms would be similar if taken from veterans of any of the 20th century conflicts. In the Gulf Veterans' Medical Assessment Programme we continue to recognise new cases of post-traumatic stress disorder.2 We present four histories of people who served in the Gulf during the conflict. All patients were provisionally diagnosed by RG and the diagnoses confirmed by consultant psychiatrists.

Usually the diagnosis is not difficult, and its initial recognition is within the ability of all medical practitioners. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV),3 initiation of post-traumatic stress disorder comprises experiencing, witnessing, or being confronted with a catastrophic stressor event that involves actual or threatened death or serious injury or a threat to the physical integrity of self or others. The response involves intense fear, helplessness, or horror (box).