Posttraumatic Stress Disorder: A Serious Mental Illness

Just as schizophrenia and bipolar disorder are considered serious mental illnesses, so should posttraumatic stress disorder (PTSD), a condition whose prevalence in the United States exceeds the combined prevalences of these other two disorders. People who have PTSD can expect, on average, to endure over two decades of active symptoms and to miss almost 1 day of work per week. They have a 20% chance of attempting suicide, an outcome that is not fully explained by the presence of comorbid depression (1, 2). The destructive effect of PTSD on intimate attachments and sources of support is well recognized. Overall, PTSD imposes a heavy burden on the health care system (3).

Can PTSD be effectively treated? Until about 5 years ago, we had only a limited appreciation of how effective treatment could be. What little we knew led us to believe that gains were only modest and treatment largely palliative. More recent reports of trials assessing selective serotonin reuptake inhibitors and exposure-based psychosocial therapies have fortunately painted a much brighter picture, and it is now justifiable, indeed best practice, to think of remission as the desired outcome (4, 5). It is also important to keep in mind that most survivors of trauma do not develop PTSD. Could innate human resilience have a protective effect? Is it possible to promote resilience with our known effective treatments? Evidence suggests that this may be so (4). The articles presented in this edition of Focus serve as timely elaborations on these themes.