PTSD vs. PTSI

PTSD vs. PTSI

Science and Stigma: The Bases for Arguments to Change the Name

Arguments for Changing the Name

The American Psychiatric Association (APA) added PTSD —  coined in 1980 for severe, trauma-related symptoms among veterans of military engagement — to its third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM). While the recognition was monumentally important then, a strong case can be made to think and talk differently about the condition today. More than 40 years later, we it’s clear that a shift from “disorder” to “injury” is necessary, if not overdue.

Argument 1

From a scientific perspective, the “D” in PTSD is outdated. Seeing is believing.

The “D” in PTSD is outdated. Seeing is believing.

“Injury,” in the medical context, is primarily based on traditional definitions and categorizations that focus on observable physical harm to the body. Injuries can range from minor cuts and bruises to more severe conditions like fractures, sprains, strains, dislocations, burns, or internal organ damage. Diagnoses related to internal injury are often determined using advanced imaging technology (fMRI, PET scans). The technology can now detect physical changes in the brain following post-traumatic stress (PTS), but it was NOT available in 1980. These changes may include alterations in neural connectivity, activation patterns, or even structural changes in specific brain regions.

While it is understood, and even even accepted, that terminology and conceptual frameworks within medicine often require time to adapt and incorporate advancements, like the ones mentioned above, the time has come to change the current classification/diagnosis of PTSD to PTSI. The once “invisible“ wounds of brain injury following psychological trauma can now be observed in the brains of people diagnosed with post-traumatic stress and, thus, should be considered “injured.”

The efficacy of diagnostic imaging, and the importance of its role in determining treatment for the injured, should not be ignored when considering the effects — and the survivors — of severe trauma. The current model of a “disorder” does not consider the latest, widely-accepted neuroscience developments and, thus, renders the “D” in PTSD to be clearly outdated, from a scientific perspective.

The use of brain scans to diagnose PTS have proved inconclusive, yet there is abundant evidence for changes in the structure and function of different areas of brain involved in fear response and anxiety, regulation of emotions, cognitive processing and memory. For example, Michael T. Alkire, M.D. — featured in a 60 Minutes segment about the use of SGB to treat PTSD — has demonstrated over-activation of the amygdala in patients with PTS as far back as 2015 in his work for VA Long Beach Healthcare System.

1. Hippocampal Volume Reduction: One of the most consistently reported findings in the literature is a reduction in the volume of the hippocampus in individuals suffering post-traumatic stress. The hippocampus is involved in memory formation and retrieval. It’s still debated whether this reduction is a result of trauma exposure or if it’s a pre-existing condition that makes individuals more susceptible to developing post-traumatic stress. (https://www.sciencedirect.com/science/article/abs/pii/S0006322302013598)

2. Changes in the Amygdala: The amygdala plays a crucial role in emotional processing and the formation of emotional memories. Some studies have found changes in the amygdala’s structure and function in individuals with trauma exposure and PTS.

3. Prefrontal Cortex Alterations: The prefrontal cortex, particularly the anterior cingulate cortex (ACC) and the medial prefrontal cortex (mPFC), is implicated in emotion regulation, decision making, and cognitive processing. Changes in these areas have been reported in individuals with PTS.

4. Functional Connectivity Changes: Advanced imaging techniques like functional MRI (fMRI) have identified altered patterns of connectivity between brain regions in individuals with PTSs. These changes can impact how different brain areas communicate and work together.

5. Neurochemical Changes: Trauma and the development of PTS can also impact the levels of various neurotransmitters and hormones in the brain, including cortisol, norepinephrine, and serotonin.

6. Neuroplasticity: Repeated trauma can impact the brain’s ability to adapt and change in response to new experiences, a process known as neuroplasticity. Traumatized individuals might experience alterations in this capacity.

Argument 1

From a scientific perspective, the “D” in PTSD is outdated. Seeing is believing.

The “D” in PTSD is outdated.
Seeing is believing.

“Injury,” in the medical context, is primarily based on traditional definitions and categorizations that focus on observable physical harm to the body. Injuries can range from minor cuts and bruises to more severe conditions like fractures, sprains, strains, dislocations, burns, or internal organ damage. Diagnoses related to internal injury are often determined using advanced imaging technology (fMRI, PET scans). The technology can now detect physical changes in the brain following post-traumatic stress (PTS), but it was NOT available in 1980. These changes may include alterations in neural connectivity, activation patterns, or even structural changes in specific brain regions.

While it is understood, and even even accepted, that terminology and conceptual frameworks within medicine often require time to adapt and incorporate advancements, like the ones mentioned above, the time has come to change the current classification/diagnosis of PTSD to PTSI. The once “invisible“ wounds of brain injury following psychological trauma can now be observed in the brains of people diagnosed with post-traumatic stress and, thus, should be considered “injured.”

The efficacy of diagnostic imaging, and the importance of its role in determining treatment for the injured, should not be ignored when considering the effects — and the survivors — of severe trauma. The current model of a “disorder” does not consider the latest, widely-accepted neuroscience developments and, thus, renders the “D” in PTSD to be clearly outdated, from a scientific perspective.

The use of brain scans to diagnose PTS have proved inconclusive, yet there is abundant evidence for changes in the structure and function of different areas of brain involved in fear response and anxiety, regulation of emotions, cognitive processing and memory. For example, Michael T. Alkire, M.D. — featured in a 60 Minutes segment about the use of SGB to treat PTSD — has demonstrated over-activation of the amygdala in patients with PTS as far back as 2015 in his work for VA Long Beach Healthcare System.

1. Hippocampal Volume Reduction: One of the most consistently reported findings in the literature is a reduction in the volume of the hippocampus in individuals suffering post-traumatic stress. The hippocampus is involved in memory formation and retrieval. It’s still debated whether this reduction is a result of trauma exposure or if it’s a pre-existing condition that makes individuals more susceptible to developing post-traumatic stress. (https://www.sciencedirect.com/science/article/abs/pii/S0006322302013598)

2. Changes in the Amygdala: The amygdala plays a crucial role in emotional processing and the formation of emotional memories. Some studies have found changes in the amygdala’s structure and function in individuals with trauma exposure and PTS.

3. Prefrontal Cortex Alterations: The prefrontal cortex, particularly the anterior cingulate cortex (ACC) and the medial prefrontal cortex (mPFC), is implicated in emotion regulation, decision making, and cognitive processing. Changes in these areas have been reported in individuals with PTS.

4. Functional Connectivity Changes: Advanced imaging techniques like functional MRI (fMRI) have identified altered patterns of connectivity between brain regions in individuals with PTSs. These changes can impact how different brain areas communicate and work together.

5. Neurochemical Changes: Trauma and the development of PTS can also impact the levels of various neurotransmitters and hormones in the brain, including cortisol, norepinephrine, and serotonin.

6. Neuroplasticity: Repeated trauma can impact the brain’s ability to adapt and change in response to new experiences, a process known as neuroplasticity. Traumatized individuals might experience alterations in this capacity.

Argument 2

Argument 2

Stigma is a barrier to seeking help.

Stigma is a barrier to seeking help.

The unintended effect of diagnosing post-traumatic stress as a “disorder” continues to carry with it stigma and shame — a perception shared by society at-large — and it has proven to be a barrier to seeking help. Too often, suicide and lives led in misery have been the result. So, how do we know that changing one word of the official diagnosis might lead to the reduction of stigma and save lives?

Post-traumatic stress
is a real “injury”

Retired General Peter Chiarelli, former
Vice Chief of Staff of the U.S. Army would also, now, state the injury is visible.

The experience and tireless efforts of
a decorated U.S. Army General

U.S. Army General (retired) Peter Chiarelli spent nearly 40 years of his life serving others while in the U.S. Army. As commander of the Multi-National Corps-Iraq, he coordinated the actions of all four military services and was responsible for the day-to-day combat operations of more than 147,000 U.S. and Coalition troops. While serving as the 32nd Vice Chief of Staff in the Army from 2008 to 2012, Chiarelli was responsible for the day-to-day operations of the Army and its 1.1 million active and reserve soldiers. It was during this time that General Chiarelli led the Department of Defense efforts on post-traumatic stress (PTS), traumatic brain injury (TBI), and suicide prevention.

By using the term “injury,” Chiarelli and others believe that it more accurately reflects the nature of the condition as something that happens to an individual, rather than something being “wrong” with the individual. Just as soldiers wouldn’t be ashamed of a physical injury received in the line of duty, the hope is that they wouldn’t be ashamed of a psychological injury either.

In a 2011 interview with PBS NewsHour, Army Vice Chief of Staff Gen. Peter Chiarelli elaborated further, saying that the term “disorder” perpetuates a bias against the condition and “has the connotation of being something that [was] a pre-existing problem” for an individual before enlisting in the Army, adding that the label “makes the person seem weak.” He continued, “It seems clear to me that we should get rid of the ‘D’ if that is in any way inhibiting people from getting the help they need,” Chiarelli said. Calling it an injury instead of a disorder “would have a huge impact,” encouraging soldiers suffering from the condition to seek help.

[Note: Immediately after retiring from the U.S. Army in early 2012, General Chiarelli became the first CEO of One Mind, the leading brain health nonprofit committed to healing the lives of people impacted by brain illness and injury through global, collaborative action. He has since retired as CEO and remains an Ambassador for the cause. ]

Post-traumatic stress is a real “injury”

Retired General Peter Chiarelli, former Vice Chief of Staff of the U.S. Army would also, now, state the injury is visible.

The experience and tireless efforts of a decorated U.S. Army General

The experience and tireless efforts of a decorated U.S. Army General

U.S. Army General (retired) Peter Chiarelli spent nearly 40 years of his life serving others while in the U.S. Army. As commander of the Multi-National Corps-Iraq, he coordinated the actions of all four military services and was responsible for the day-to-day combat operations of more than 147,000 U.S. and Coalition troops. While serving as the 32nd Vice Chief of Staff in the Army from 2008 to 2012, Chiarelli was responsible for the day-to-day operations of the Army and its 1.1 million active and reserve soldiers. It was during this time that General Chiarelli led the Department of Defense efforts on post-traumatic stress (PTS), traumatic brain injury (TBI), and suicide prevention.

By using the term “injury,” Chiarelli and others believe that it more accurately reflects the nature of the condition as something that happens to an individual, rather than something being “wrong” with the individual. Just as soldiers wouldn’t be ashamed of a physical injury received in the line of duty, the hope is that they wouldn’t be ashamed of a psychological injury either.

In a 2011 interview with PBS NewsHour, Army Vice Chief of Staff Gen. Peter Chiarelli elaborated further, saying that the term “disorder” perpetuates a bias against the condition and “has the connotation of being something that [was] a pre-existing problem” for an individual before enlisting in the Army, adding that the label “makes the person seem weak.” He continued, “It seems clear to me that we should get rid of the ‘D’ if that is in any way inhibiting people from getting the help they need,” Chiarelli said. Calling it an injury instead of a disorder “would have a huge impact,” encouraging soldiers suffering from the condition to seek help.

[Note: Immediately after retiring from the U.S. Army in early 2012, General Chiarelli became the first CEO of One Mind, the leading brain health nonprofit committed to healing the lives of people impacted by brain illness and injury through global, collaborative action. He has since retired as CEO and remains an Ambassador for the cause. ]

Study convincingly shows renaming
PTSD to PTSI would reduce stigma

Addressing attendees at an American Psychiatric Association conference, Dr. Eugene Lipov presents evidence for change to the DSM

Dr. Eugene Lipov to the APA:
“…an important thing to think about.”

Dr. Eugene Lipov is one of the world’s leading experts on the treatment of symptoms related to post-traumatic stress. A true pioneer in stellate ganglion treatment for symptoms of PTS, he has made it his mission to help others relieve their traumatic suffering from PTS and restore hope to their spirit.

Addressing attendees at an American Psychiatric Association conference in the spring of 2023, Dr. Lipov points to “an important thing to think about,” as he presented a study that revealed the overwhelming potential — positive — impact of changing PTSD to PTSI. He led the recent peer-reviewed study, conducted by Stella Trauma Centers, in which a survey assessed participants’ opinions on whether renaming PTSD to PTSI would reduce stigma and improve their hope and likelihood of seeking medical help.

Citing the findings of other peer-reviewed research:

“Stigma has been repeatedly highlighted as the key barrier to help-seeking behaviors. Studies on mental health disorders have shown that self-stigmatization may decrease treatment-seeking and undermine adherence to treatment recommendations. In fact, most veterans choose to cope without treatment, relying on their own resilience and, in some cases, on substance use. As a result of refraining from seeking mental health services due to stigma, patients with PTSD may endure extreme and life-threatening consequences such as depression, substance abuse, and suicide.

The results revealed that over two-thirds of the respondents agreed that changing the name to PTSI would reduce the stigma associated with PTSD. More than half of the respondents believed this name change would increase their hope of finding a solution and their likelihood of seeking medical help.

Study convincingly shows renaming
PTSD to PTSI would reduce stigma

Study convincingly shows
renaming PTSD to PTSI
would reduce stigma

Addressing attendees at an American Psychiatric Association conference, Dr. Eugene Lipov presents evidence for change to the DSM

Dr. Eugene Lipov presents to the APA: “…an important thing to think about.”

Dr. Eugene Lipov presents to the APA: “…an important thing to think about.”

Dr. Eugene Lipov is one of the world’s leading experts on the treatment of symptoms related to post-traumatic stress. A true pioneer in stellate ganglion treatment for symptoms of PTS, he has made it his mission to help others relieve their traumatic suffering from PTS and restore hope to their spirit.

Addressing attendees at an American Psychiatric Association conference in the spring of 2023, Dr. Lipov points to “an important thing to think about,” as he presented a study that revealed the overwhelming potential — positive — impact of changing PTSD to PTSI. He led the recent peer-reviewed study, conducted by Stella Trauma Centers, in which a survey assessed participants’ opinions on whether renaming PTSD to PTSI would reduce stigma and improve their hope and likelihood of seeking medical help.

Citing the findings of other peer-reviewed research:

“Stigma has been repeatedly highlighted as the key barrier to help-seeking behaviors. Studies on mental health disorders have shown that self-stigmatization may decrease treatment-seeking and undermine adherence to treatment recommendations. In fact, most veterans choose to cope without treatment, relying on their own resilience and, in some cases, on substance use. As a result of refraining from seeking mental health services due to stigma, patients with PTSD may endure extreme and life-threatening consequences such as depression, substance abuse, and suicide.

The results revealed that over two-thirds of the respondents agreed that changing the name to PTSI would reduce the stigma associated with PTSD. More than half of the respondents believed this name change would increase their hope of finding a solution and their likelihood of seeking medical help.