Posttraumatic stress disorder (PTSD) has been associated with military activities for as long as wars have been fought – but this disorder was only named in the 1980s. A new Yale paper published April 16, 2018 in Chronic Stress documents a different kind of war – a war of words – that has been fought over the name of the disorder, and may have slowed clinical and scientific progress on the disorder.

The study looked back through 14 million newspaper articles between 1900-2016, and found trauma-related symptoms such as flashbacks, trouble sleeping, and severe anxiety were called different names after World War I, World War II, Vietnam, and the Gulf War. Terms such as shell shock, war neurosis, and battle fatigue were used to describe symptoms that many soldiers experienced after returning home from war.

The Yale-led research team used a complex computer coding program to comb through the archives of the New York Times, Reuters, and Associated Press, and found that as each war came and went, a new term was used to describe the disorder now referred to as PTSD. They argue that the lack clear terminology may have slowed professional understanding, knowledge, and research into PTSD.

“Each (military) conflict basically had its own new name for what were really the same group of symptoms,” said Adam Chekroud, PhD, Assistant Professor of Psychiatry and the paper’s first author. “For us, this was an opportunity to dig into the data, and to quantify this phenomenon.”

The paper revealed that PTSD symptoms were known as shell shock during World War I, and irritable heart or soldier’s heart during World War II. The term gross stress reaction was introduced in the first edition of the Diagnostic and Statistical Manual in 1952, but was omitted in a second edition in 1968 during the Vietnam War.

It wasn’t until 1980, with the publication of the manual's third edition, that the term PTSD was introduced to describe military trauma and non-war related factors, such as sexual abuse. “PTSD has existed forever,” Chekroud said. “It’s just a question of what we’ve been calling it.”

Chadi Abdallah, MD, Assistant Professor of Psychiatry at Yale and the editor of Chronic Stress, said the history of disjointed terminology resulted in a 60-year delay in understanding traumatic symptoms experienced by veterans and others.

“Society finally recognized that many people were suffering from the same symptoms,” he said. “(The study) provides objective measures to how society has reacted to this invisible wound of war.”

John H. Krystal, MD, Robert L. McNeil, Jr. Professor of Neuroscience at Yale and Chair of the Yale Department of Psychiatry, was senior author of the study