Post-traumatic Stress Disorder

This is the best current academic book on posttraumatic stress disorder (PTSD) that I know of. Its strengths are its evidence-based reviews of nosology, neurobiology, pharmacotherapy, psychotherapy, and disaster mental health. It includes theoretical approaches in biological, developmental, psychological, and psychosocial dimensions. It addresses factors both in vulnerability and in resilience. Each chapter includes commentaries by experts, who give added perspective. The references, from a huge literature, are selective, current, extensive, and excellent. The contributors, who are also on the DSM-5 Task Force for Anxiety Disorders, include editors Drs. Dan Stein and Matthew Friedman, as well as Murray Stein and Robert Ursano. The chapters that hooked me were the first three.

The first is “PTSD and Related Disorders,” by Matthew Friedman. It elegantly reflects his broad knowledge. He proposes revisions for the DSM-5, with the final to be released in 2013 (www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165). He concludes that the major revisions would be a relatively conservative revision of DSM-IV. Based on evidence, the recommendation is to modify criterion A1, objective stressor events, and to eliminate criterion A2, subjective fear, fear, helplessness or horror. Regarding other criteria, instead of the current three, there would be four clusters—reexperiencing symptoms, avoidance behavior, negative alterations in cognitions and mood, and alterations in arousal and reactivity—and all B–G symptoms would be specifically anchored after the traumatic event.

The second chapter is on the epidemiology of PTSD and written by Carlos Blanco. It not only highlights the specific stressors and the range of symptoms occurring in different populations but also lends an international perspective.

The neurobiology chapter, by Arieh Shalev, Asaf Gilboa, and Ann Rasmusson, is an especially delightful read and addresses the sophisticated neuroscience of PTSD clearly and accessibly. The contributors present the latest discoveries about PTSD in fear conditioning and extinction, monoamines, neuroendocrine modulation, genetics and epigenetics, structural and functional neuroanatomy, and a synthesis of human and animal studies.

In addition to these three remarkable chapters, the chapter on the pharmacotherapy of PTSD is presented accurately and thoroughly and focuses on evidence-based treatments, which are far fewer than the full range of published studies. “Psychological Interventions for Trauma Exposure and PTSD,” by Richard Bryant, a major authority in this field, clearly and concisely presents strong evidence for an expanding field of treatment.

“(Disaster) Public Mental Health,” by Joop de Jong, is a thoughtfully detailed review, enriched by the author's wisdom in international public mental health, and includes a special focus on disaster mental health of low- and middle-income countries. A concluding commentary by Robert Ursano and colleagues on the issues raised by Dr. de Joop adds the critical point that disasters result not only in bodily injury and death, but in mental health problems that can far outweigh physical casualties in illness burden and cost—yet an adequate mental health response is rarely planned or funded for communities.

This is a fine book. For those treating patients with PTSD, conducting research, or involved in disaster psychiatry, this is essential reading, and worth owning.