The Importance of Past Psychological Trauma and Pathophysiological Process as Determinants of Current Biologic Abnormalities

Abstract

To the Editor.— Most recent studies of putative biologic abnormalities in psychiatric disorders have made an attempt to relate the biologic variables to DSM-III or Research Diagnostic Criteria (RDC) entities. These entities are usually defined as clusters of symptoms and signs, to which time course and degree of impairment are sometimes added. Such emphasis on an atheoretical phenomenology is aimed at enhancing agreement among clinicians and investigators and is expected to facilitate objective research. The process leading to the formation of clinical features, whether psychodynamic, psychophysiologic, or both, is usually considered to be secondary in diagnostic importance (with the exception of recognizable immediate organic or situational causes), and many times is completely ignored. Posttraumatic stress disorder (PTSD) is one of the exceptions to the above rule because of the emphasis on the past psychologic trauma as the stressor. The actual symptoms may vary and go beyond the reexperiencing of