Talk:Post-traumatic stress disorder/Archive 6

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Why is there rape imagery on an article about PTSD?

[NOT ARCHIVED - is an unresolved issue to which response is needed. Tom Cloyd (talk) 22:38, 10 December 2011 (UTC)]

Primary objection: the image is too explicit, and of questionable appropriateness

It is despicable to have rape imagery (The Rape of Lucretia by Felice Ficherelli ) on a page about PTSD. People with PTSD can be triggered by seeing that.

And for the record, Lucrecia committed suicide the next day, so she's not even a good historical/mythical example of PTSD. 174.130.231.93 (talk) 03:49, 17 August 2011 (UTC)

I agree with the anon, although I can't speak for the historical accuracy. Can we find an image that's not a potential trigger? AntiSlice (talk) 06:00, 17 August 2011 (UTC)

PTSD can be triggered by this picture? Do you have a review article to back that up.Doc James (talk · contribs · email) 06:23, 23 August 2011 (UTC)

Actually, I think the reference to "trigger" is about a common phenomenon with traumatized people, where something that their brain associates with an historical trauma triggers a flashback because their memory of the trauma is not resolved. Resolved memories are perfectly clear, but do not produces substantially noxious affect with activated. The problem with anticipating triggers, however, is that it's hard to do. Experienced clinicians know that all sorts of things trigger flashbacks, and that triggers tend to be both highly varied and distinct to the individual concerned. Traumatized people typically know their triggers, and simply act to avoid them whenever possible (and it isn't always possible).

I agree that this image might be a trigger for someone, as might be "sexual" (which appears in the lede, "sexual abuse", "violent assault", "sexual assault" and a very number of other words or phrases that occur in the "Causes" section, among other places.

I'm just not sure it's a reasonable request that an article on PTSD be "cleansed" of potential trigger images, words, phrases, etc. Highly triggerable people will just avoid articles about things which might set off their flashback. Such avoidance is HIGHLY predictable, as it's one of the formally specified symptoms of the disorder.

Tom Cloyd (talk) 08:02, 23 August 2011 (UTC)

No, people with PTSD symptoms may well look it information about it, perhaps to understand their situation, etc. But what an idiot whoever posted the rape of lucretia pic! - definite trigger - was it some kind of sick joke? When people have a 'disorder' they are not going to ignore things associated with it, or how would they go about getting better? NB: Anyone who posts pictures of that nature, or similar imagery obviously is operating in the wrong field, and should be ideally editing the wiki entry on 'internet trolls'. Does the page need a picture at all? Maybe it should have pictures of warfare, or severely maimed comrades to remind soldiers of the cr*p they went through - or is that different somehow? Think people, think. — Preceding unsigned comment added by 84.12.125.50 (talk) 07:12, 1 September 2011 (UTC)

Please read the rest of this section. The "triggering" objection has been well-discussed. And please cease the name-calling. It is not argumentation, and does not advance the discussion in any way.

Your suggestion as to change of content from rape to warfare has also been discussed, and dealt with. Basically, it would be misleading to do this. Tom Cloyd (talk) 15:39, 29 September 2011 (UTC)

Response to this objection

Quick answer, 'cause I'm desperate to get maybe 3 hours sleep before a plane flight...

The painting is one of scores depicting the same legendary incident, the assault by one man of another's wife, which is said to have led to the founding of the Roman Republic. The incident is famous in legend, literature, and art.

For obvious reasons, to get an image of "PTSD" is essentially impossible. However, to get an image of something meaningfully related is not. Most people think of PTSD as something that happens to soldiers, and it is, but by a 2 to 1 margin it happens to women more often (read the article for the sourcing on this), and this is little known. AND the dominant cause of psychological trauma in women is sexual assault. Now does the use of this painting make more sense? It should, I would think. It points to an important, little known central truth about PTSD.

It not only depicts probable psychological traumatization, the victim is also of the correct gender to depict the dominant victim type, as is the nature of the trauma itself. As an aside, that a soldier is a perpetrator is also a comment on the fact that soldiers undoubtedly cause more PTSD then they experience, as non-combatant civilians are always the major victims of modern wars (and likely of many ancient ones, as well). There are just so many things right about this image.

At least as important, in my mind (I found and added the painting), the use of this image, or something like it, serves as an advertisement for the truth: women are far more often the victims of PTSD than are men (although they are largely neglected, relative both to diagnosis and to treatment) - now THAT's despicable! Use of this painting may well act for positive educational effect, if only because it depicts a soldier perpetrator and a female victim.

Regarding triggering - what relevant image would not be? I treat PTSD as a specialty, and in my experience people who are easily triggered do not go reading about PTSD (although surely some do) - some are triggered merely be reading about the symptoms. That triggering is a key symptom, of course, as is the avoidance of triggering stimuli. What can we do about this? Make effective treatment more readily available, because PTSD IS treatable and curable. But again, many people do not know this, and that's tragic.

Regarding appropriateness of "Lucretia": first, we don't really know if the event even happened, much less what happened the next day, so we can't get too picky about that. The point of the image isn't Lucretia, but rather what is depicted. The image of a legendary/historical sexual assault (and there are many - e.g., Leda and the Swan; The Rape of Europa, etc.) is about as removed from reality as we can get and still have an image of the dominant cause of psychological trauma for the gender most often affected. Of course it's an ugly scene. That's the nature of things that cause psychological trauma, and especially of assault, and most especially of sexual assault. There's nothing nice either the cause or the frequent result: posttraumatic stress disorder. Let's tell the truth about that, OK?

I realize there are negative aspects to this image, as there would be to any, but we've been looking a long time, and this is the first image we've found that both fits and is public domain. Our alternative is to have none. I really don't think that's our best choice. I'm certainly open to considering alternatives, but no one has offered any that we've been able to keep, sadly...until now.

Tom Cloyd (talk) 09:25, 18 August 2011 (UTC)

Responses to the "response" section above

Seriously? No pictures of a warzone? It's not that hard! CeeKyuuCee(talk) 01:29, 19 August 2011 (UTC)

Correct, but use of such an image would simply perpetuate the gross injustice of most people's believing that PTSD is something that happens mostly to soldiers. Wikipedia is about providing well-sourced, accurate informational summaries. A warzone image would be a visual mislead, an image perpetrating a misperception. We really have to do better than this, I think. Tom Cloyd (talk) 06:06, 20 August 2011 (UTC)

Part of what makes the "but we need a picture of an event that's representative of ones that cause PTSD" argument really not work for me on this image is how sexually Lucretia is portrayed. It seems to me to send the message of "well yes, this is a terrible thing, but she sure does look good!" A lot of rapes happen without a woman being naked and tangled up in artfully-draped sheets. I don't deal with triggers myself so I am not going to comment on balancing the need to display some image, but I really would rather have no image than one that makes the scene look so sexualized. 128.208.236.94 (talk) 21:17, 18 August 2011 (UTC) (quartzpebble)

An image of a sexual assault that avoids or minimizes sex? So, how would we know that the assault is not about, say, stealing jewelry? Your suggestion sounds just a little absurd to me. The painting is obviously a period piece. They all are. Women in art are more often naked than are men. If we had an image by Picasso, it's likely the woman would also be unclothed. You, and others, are objecting to an image that tells a truth, at least as much expressively as literally. Expressionism versus literalism is one of the great distinctions in fine art. To exaggerate for effect is an entirely legitimate tactic in most, if not all arts. Michelangelo's hand of Adam reaching out to touch the hand of God, depicted on the Sistine chapel, is not literal. It's expressive, and also metaphorical. And wholly legitimate, as art.

The cover of the Journal of the American Medical Association very often is dominated by some work of fine art which relates, and not always in an obvious way, to some medical fact, event, issue, or concept. It is understand that people will know that they are looking both at a work of art and a kind of illustrative use of art. That is also what I'm trying to do here, and such a use of art has a long tradition, I would propose.

Rape is about sex, and nakedness simply says that better than non-nakedness. I'd rather you object to the truth: this mental illness occurs mostly to women, and most people ignore this because they think otherwise. As a result, not only do soldiers not get adequate treatment, women, as a group get an even worse response from society. The real problem with the image isn't what it shows, but that it shows an awful truth - several of them, in fact. Why are you not objecting to those truths, I have to wonder...? Tom Cloyd (talk) 06:06, 20 August 2011 (UTC)

I realize that the painting is a period piece and agree with your main point--that a greater awareness of women's PTSD, and the fact that it tends to come from sexual violence, would be beneficial (see comment below on graph proposal). However, I do not think that these points make this image an appropriate one, and would generalize my comments to similar pieces.

"Does not sexualize" does not translate to "avoids or minimizes sex", but rather to "does not make the scene sexually compelling or inviting". "Sex" does not translate to "attractive naked woman" (never mind that whenever people say things like "sex sells" that's what they seem to mean). Rape is a sexual assault, yes, but the "assault" piece of that is often more important than the "sex"--it's about control and domination, not about inability to restrain one's urges. Again, I know that it's a period piece. Lucretia still looks like a lot of other nudes of that era, ones who *are* supposed to look attractive and sexy. In general, the fictional portrayals of rape--even relatively graphic ones--that I've found add to whatever story they're in (visual, movie, etc.) and in some ways disturb me less are emphatically not the ones where the victim is portrayed in an inviting or sexual manner, or where there's an implicit narrative of "She looked so good, he couldn't control himself." 24.19.250.242 (talk) 07:01, 20 August 2011 (UTC)(quartzpebble)

And what makes you think your subjective response - that the woman portrayed is sexually inviting - generalizes? I have never seen the image that way, for example. There is a long, long tradition in European, and recent Classical, Romantic, and even Impressionistic and Cubist art of portraying women, and no few men, with little or no clothing. There are many reasons for this. My thought, reading your comment above, is that you may be underexposed to such art. I may be wrong.

As for the motive of rape, the often repeated idea that it is about control more than sex has, so far as I know, only folkloric support. In the case of the event depicted, the motive, according to the story was political. THAT's the implicit narrative, not the one you suggest. And, of course, from the victim's point of view, motive is irrelevant, so we need not concern ourselves with it. The core idea of the picture in the context of this article is, to me, [a] assault, [b] of a sexual nature, [c] of a woman. ALL of this is highly relevant to the article. as I have previously pointed out. Tom Cloyd (talk) 08:24, 23 August 2011 (UTC)

Point - Rape is not about sex, its about power. Or the perpertrators lack of it in 'real' life. Examine the picture and you should see exactly that - is the man raping the woman at that point or is he depicting a position on power over another, leaving them powerless to act. That is what PTSD is essentially about - being powerless to act in a situation, and the minds reaction. Let us just remember that PTSD is about the mind - the minds response to a traumatic event. Not every rape victim develops PTSD, so perhaps an artistic picture is inappropriate. Leave it on the page of the artist please. Perhaps a pic, if you absolutely need one, should be someone appearing catatonic, or better still some sort of diagram, picture of the brain, etc. — Preceding unsigned comment added by 84.12.125.50 (talk) 07:21, 1 September 2011 (UTC)

"Rape is not about sex, it's about power." Evidence, please? I hear this repeatedly, but always said gratuitously. I know of no evidence for this. It is also beside the point. That a use of power is usually a part of a rape event does not allow us to conclude that it is ABOUT power.

'An "artistic" image is inappropriate because not all rape victims develop PTSD?' You just lost me on that one; that makes no sense.

'We need an image of something traumatic which ALWAYS produces PTSD?' Like what?

If you have an alternative image, show it here, please. This present image works, for a number of reasons I've reviewed, and I have more important things to do on this article than to keep looking for a replacement image. It's a difficult problem, else it'd have been solved sooner. Tom Cloyd (talk) 15:34, 29 September 2011 (UTC)

Objections to "Lucretia" image

Coming in late, I know. I won't offer an opinion on the appropriateness of a rape image for this article, as I can see arguments for both sides (violence made sexy and triggering readers vs. image blockers and not misleading readers as to prevalence). However, an image of Lucretia is inappropriate, since, as the IP pointed out, she killed herself the following day! This is not a good example of PTSD. Perhaps one of the Goya images from Caprichos or Disasters? –Roscelese (talk ⋅ contribs) 07:40, 29 September 2011 (UTC)

I'm almost laughing. On the one hand you appear to see unclothed women in classical art as "sexy" (leading me to wonder as to the extent of your exposure to classical art and this "unclothed" convention), and on the other you get picky as to the details of the Lucretia story, as if most readers will have any awareness of this at all. But most critically, you have missed this point, previously made: the painting is not an image of PTSD (how could we portray THAT graphically???), but of the sort of precursor event which [a] is required in a person's history for the diagnosis to be made at all, and [b] which is likely to cause PTSD in some people. If you have candidate alternative images, please show them here so we can discuss them. Tom Cloyd (talk) 15:46, 29 September 2011 (UTC)

Wow, dude, lack of awareness of how violence against women gets portrayed as sexy is a pretty awkward blind spot to have. As I already said in my comment, there are other images of rape to choose from. For all we know, the woman in this image didn't suffer from PTSD either, but choosing an event where the person explicitly did not develop PTSD is a strange choice for an article on PTSD. –Roscelese (talk ⋅ contribs) 16:01, 29 September 2011 (UTC)

"...violence against women gets portrayed as sexy..." Oh really? Where? Not in my culture. In comic books? Cartoons? Video games, perhaps? Not my culture, and I wouldn't know. This is classical art, and that characterisation may not, in that context, be made glibly. Please find a reputable reference for this, else you're merely offering your opinion, in contrast to mine. In fine art, I have not seen the portrayal of rape as sexy in any significant way. What I have seen in abundance is reactions to nudity in art which completely misconstrue its meaning due to utter lack of awareness or concern for the context in which the art was produced. That makes the reaction, howsoever subjectively authentic, both ill-informed and irrelevant, from my perspective.

I fear that you're completely missing the historical context. For example, when looking at 1500 year old Byzantine icons, we necessarily view them in their historical and religious context, to make any sense of them at all. Why would we approach the painting used for this article any differently? This is a classical painting, and of an event in a Roman legend, and both those facts have considerable relevance. Two things very common to the period are seen in the painting: [a] the clothing design used reflects the time of the painter; and [b] the unclothed portrayal of the female, widely done at this time, mimics what the artists of the time knew of Roman and Greek art, which was widely admired and often portrayed unclothed bodies, especially of women.

The nakedness is therefore referential, and in no way indicates inherent prurient intent. It indicates awareness of an interest and respect, found in the general class of art consumers of the time, for whom all things having to do with Rome and Greece tended to be interesting and respected. In a way, living as I do in the western USA, I might refer to this as an example of the "cowboy art" of its time - it was painted FOR a particular class of consumers, while not being about them but about a group of people of interest to them. The use of contemporary rather than period clothing, very common in art of this time, was a tactic used to decrease the distance between the painting and its the viewer.

To look at this and see a bare body and immediately think "sex" is simply provincial. In placing this image here, I assume the reader will have SOME exposure to classical art history of the late part of the second millennium in Europe, and will have at least a passing familiarity with its conventions. If, in spite of this, one wishes to think "sex", that's a little sad, especially given the narrative nature of the image. This is a sexual assault. I fail to see anything sexy about that.Tom Cloyd (talk) 00:42, 1 October 2011 (UTC)

The gentleman doth protest too much, methinks - if you have to go off on wild multiparagraph tangents about how I obviously know nothing about art, that's a fairly good indication that you have no grounds on which to defend this image. There are so many sources on the aestheticizing of rape and on the Lucretia narrative specifically as erotic that it would be pointless to link them all - try searching. Now, what is your objection to a different image of rape which is actually relevant, one where it isn't 100% certain that the victim did not develop the condition which is the subject of the article? –Roscelese (talk ⋅ contribs) 14:57, 2 October 2011 (UTC)

You fault me for being thorough, both as to content and to exposition? Since when is this a problem for an intelligent person? In truth, I give you a lot to respond to, and you pass on all of it.

It is inappropriate for you to ask me to search for sources for your assertions. That is your job, in argumentation.

Your response is not how argumentation is done. You simply have not addressed my assertions, all of which were responses to yours. My assertions stand:

• that 'violence against women gets portrayed as sexy' in classical art is an unsupported assertion; (This notion is also irrelevant to improvement of this article, and should not be discussed here; the assertion that the Ficherelli painting seen here oversexualizes rape, of course, is not irrelevant - it's just not yet been supported.)
• that the understanding of a specific work of art must be done by reference to its historical context (now there's a radical notion!);
• that insistence on seeing this naked woman as "sexy", aside from being a subjective assessment, is typical of a wide range of objections to which classical art has been subject for a very long time, all driving from people with (uh-hem) limited points of view. Michelangelo's David has long been the object of vociferous objection because of his blatant nakedness. The Venus de Milo bare breasts? Scarcely less offensive. What one must grasp is that Michelangelo was imitating the Venus and others of her period, out of an admiration for classical art that has been widespread among the educated classes in Europe for a very long time. Ficherelli was without doubt doing the same thing. However, if one wants to see this painting with the eyes of testosteronized 15 year old male, well... I can't stop you.

As for using a different image, I have said repeatedly, in multiple threads: If someone has a better an image, bring it here so we can discuss it. I have never been wed to THIS image, but have said that it is the best we have yet found, which is true. If you think you can do better, show me. Tom Cloyd (talk) 18:26, 2 October 2011 (UTC)

Irrelevant to the improvement of the article, indeed - perhaps instead of continuing to waste time complaining about how no one aestheticises rape ever!! and how people who disagree just don't understand the historical context!! you might choose to explain why you went off on this massive tangent at all, since I made it perfectly clear in my first comment that my objection was to the story of Lucretia specifically as a person who definitely did not develop PTSD. I've also already linked an image, so would you care to comment on the Goya piece I suggested several days ago? –Roscelese (talk ⋅ contribs) 05:21, 3 October 2011 (UTC)

OK, it's apparent that appeals to reason are wasted on you, as is respectful response to your own assertions. You have no interest in honest argumentation (even after I gave you a link to decent article on the subject so you could brush up on how it's done),so I will invest no more time in attempting that with you. Since my responses were clearly a reply to you, if the topics were tangential, it was because you were. You attempted to advance a position by merely stating conclusions, without respectable support. That will henceforth be ignored by me, as it would by anyone with a reasonable familiarity with the rules of argumentation in western civilization since at least the time of the ancient Greeks. We need not respond to noise.

It was not clear to me that you were offering the Goya print as an alternative, else I'd have responded. I will do so now. I like Goya, but this print has grave problems:

• What was the print supposed to convey? All we have to go by is the title. The print title itself is so unclear I cannot conclusively make out the letters. The print series does have a readable title, and it's notable: "Los Caprichos". This may likely be translated as "The impulsive ones" or "The playful ones". However, looking at the entire print series (see PDF download link in documentation for the single print whose link you provided), I see a long series of very strange, puzzling prints. They are fantastical, grotesque, often in some way related to relations between men and women, and very obscure as to narrative content. It would take a scholar to tell us what any of these prints are about. So, I have NO idea of the artist's intent, with either the print you selected or the series to which it belongs. Our subjective impressions, approximately 250 years later, are at best suspect.

• What does the print convey, at the most obvious level? Is the woman being abducted? Is the man merely trying to kiss her? Are there two people trying to grapple with her? Is her protest serious or playful? We cannot conclusively answer even the simplest question: what is happening here? For this print to be a candidate for use with the PTSD article, its narrative must be crystal clear. This print fails on these grounds, if on no other.

As to your stated main objection, as I have already stated, this painting shows an assault of the sort which is necessary, in the history of a person, in order that they may be diagnosed with PTSD; it is to this extent entirely well chosen. Since the story of Lucretia says that she suicided very soon after her assault, we might supposed that she had ASD (Acute Stress Disorder), which is essentially PTSD that hasn't persisted long enough to meet the 30-day-duration criterion in the diagnostic criteria (compare the criteria for the two diagnoses, if you doubt this). She might also have suicided, as some versions of the story relate, because it was seen as the only decent response to the shame her assault brought upon her family. The point I have made about all this is the average reader will not likely even know who Lucretia was, much less the details of her story. For this reason, the details do not matter, except possibly for students of Roman history/legend.

To ask that we come up with an illustration of an assault for which it is know the result was PTSD borders on the absurd, given that the diagnosis is only 31 years old. There are many photos of assaults available, but the licensing issues usually block their use.

I have covered all major objections, in detail, without reasonable response. I need not continue to repeat myself. If the painting is to be replaced in some way, an editorial consensus must be reached. Without proper argumentation, that will not occur. The painting stays. Tom Cloyd (talk) 16:44, 3 October 2011 (UTC)

Wait, seriously? You monologue for days about how I just don't understand art, and then you object to the Goya because you personally don't understand it and aren't willing to do any research even so far as its title? You claim that I have a problem understanding historical context and that there's something wrong with me because I recognize that some artists aestheticise rape, and you reject the image because you think she might have been asking for it? You claim that any objections to the aestheticised rape can be dismissed on the grounds of historical context, while simultaneously dismissing objections to the picture's irrelevance to this article by saying that no one knows the context anyway? This is nonsense. You clearly have no interest in engaging with any of the points under discussion; I'm going to replace the Lucretia image with a different rape image. Feel free to use "Ni por esas" if you think it's better than "Amarga presencia."

I've already stated several times that I don't think we need a picture where the subject definitely developed PTSD, but that I don't think that out of all the artistic images of rape in the world, not using a picture where the subject definitely didn't is too much to ask. –Roscelese (talk ⋅ contribs) 17:27, 3 October 2011 (UTC)

Re: the Goya - "don't understand it" - yes, and I said so, and you provide no response to help me. Do you not know how to dialog?

Re: "aren't willing to do any research even so far as its title" - hogwash. I was the one, the only one, who DID do research, obviously. I do not see how you could have written that sentence, it's so obviously incorrect.

It's not what you "recognize" about the painting that counts, it's what you can substantiate, which apparently is very little.

"you reject the image because you think she might have been asking for it" - Be careful. You're verging on slander here. I most certainly did NOT say that. Shoot from the hip like that and you're likely to lose a toe.

"You clearly have no interest in engaging with any of the points under discussion" - You seriously think a third party reader would agree with you on that? I very much doubt that. I was very specifically addressing your points. Obviously. And you tried to turn that into a fault. That's perverse.

I'll say one last time: you would do well to learn how to engage in constructive, thoughtful argumentation. This process, well recognised, has evolved over several thousand years, and has a purpose: to arrive at better understandings than we start out with. When you assert, and I reply to your assertion specifically, and you ignore me, we do indeed go nowhere, and that's the problem: bad form yields bad results. Finis.Tom Cloyd (talk) 20:34, 3 October 2011 (UTC)

ABOUT SUBSTITUTING THE GOYA FOR THE FICHERELLI - I'm tickled to see someone actually come up an image substitution candidate. This is more participation relative to this subject than we've seen since our struggle with Piccaso's Guernica. However, you are not participating in this dispute in good faith. You may not assert unfounded conclusions (asking ME to find the substantiation), then when we fail to resolve the conflict decide the matter unilaterally.

I reverted your image substitution because the Lucretia image was discussed here previously, and the preponderance of opinion what that it was acceptable. There was no objection past that point. We can surely reopen the issue, but the need for wikipedia:consensus before taking action is Wikipedia policy. You cannot step around this.

Aside from your attempt to arbitrarily decide this issue, which I will never accept, I have three serious problems with the Goya you chose (and did NOT offer here for prior discussion:

• It's small and murky looking. Merely enlarging it a bit may fix this problem.
• It is far from clear what the narrative is - i.e., what's happening. It looks like someone is dying, and this would make her a civilian casuality of way, by implication. But I'm guessing, because the image, like many of Goya's prints, does not speak clearly. Why is this relevant to the article at all? If I have to ask this question, we may not have a good image.
• The title makes a clear reference to war; that does clearly connect the image to the article, but in an unfortunate way. This is objectionable on the grounds that it panders to the widely held misconception that PTSD is about war. As the article clearly states, and I have stated repeated in this thread, in the main this is simply not true. It's about assault. For women, sexual assault, and for men, physical assault. The graph I'm preparing to offer as an image substitute will hopefully make this clear, and it will be well sourced.

My primary problem is how you're managing this conflict. When you assert, you must support that assertion. Failing this, you have asserted nothing. As the prime mover in this dispute, it your obligation to assert something meaningful, to which reply may then be made. There is no way around this. If we bring in formal dispute resolution process to resolve this matter, they will say the same thing, I can easily predict. Read the artidle on argumentation and you'll see why I say this.Tom Cloyd (talk) 19:19, 3 October 2011 (UTC)

A possible alternative

I've thought about these issues long and hard, and I'm still thinking. The problem I'm trying to solve isn't an easy one. I HAVE come up with one alternative graphic, but I'll have to construct it (not really a problem), and there are advantages and disadvantages to the concept of using this graphic in place of an explicit image.

I propose that it might be possible to construct a rather straightforward, simple, bar graph which would show PTSD incidence by gender, and have each gender's bar broken into sub-bars (areas) showing relative sizes of the cause of PTSD within gender. The data on this is available, and it's pretty good data, and it would show mainly three things - all important: women get more than twice the PTSD that men do; men's PTSD is mainly caused by physical violence; and women's PTSD is mainly caused by sexual violence. This graph would meet my requirement that we tell the truth.

Using such a graph in place of an image, at the top of an article, is likely rather rare in Wikipedia. I've not yet seen a single instance of it, and there might be objection to it that we would have to fight off, to avoid having NO graphic of any kind at the top of the article. The value of such a graphic is (obviously) that it holds the reader's eye in some relevant way, and increases the likelihood of their reading the article. So, we have good reason to work on coming up with something visual to put at the top of the article.

In truth, I think it obvious that both the painting (or something like it) and the graph need to be part of this article, and if we don't use the cur rentimage at the top, I think it goes well in the "causes" section. It makes a strong point. Many people will wonder 'why this image', as well they should, and they will look for an answer in the article, and become informed. That is a good thing, as it makes the article useful, and helps to raise the general level of knowledge about this disorder.

The question isn't would you prefer a graph over this image, or ANY sexual assault image, but rather would such a graph - especially the one I propose to make - serve the article approximately as well?

What do you think?

Tom Cloyd (talk) 06:06, 20 August 2011 (UTC)

I really like that idea--as you say, the graph would highlight the difference in causes and in gender distribution. I think that would be a valuable addition, especially if done in a readable and eye-catching manner. 24.19.250.242 (talk) 07:01, 20 August 2011 (UTC) (quartzpebble)

I have a distinct graphic image in my imagination, and now I need to find the time to construct it. I well may do so incrementally, elaborating the image to its conceived-of endpoint as time permits.

I strongly do not wish anything in the article to cause unnecessary distress, while at the same time think that our priority should be to provide accurate, verifiable information. It does not surprise me that the path to this goal is neither short nor without some contention. That's actually most likely a good thing. I will begin work as soon as possible on this graphic. Tom Cloyd (talk) 01:26, 22 August 2011 (UTC)

The image illustrates the issue well. Thus I support keeping it. I have seen many more cases of PTSD from rape than from war.Doc James (talk · contribs · email) 06:25, 23 August 2011 (UTC)

Your clinical experience reflects what the data tell us: Women are victims of PTSD more than twice as often as men, and women get it mostly from sexual violence of various sorts. That applies to populations not in a war zone. When in a war zone, given that war impacts civilians approximately 10 times more than it affects soldiers, one can well imagine the differential incidence of PTSD, given that women are far more prevalent in civilian than military populations. The lay population's association of PTSD with men is very misguided. Tom Cloyd (talk) 16:06, 23 August 2011 (UTC)

Let us not forget that women are more likely to report psychological problems than men. However this is the statistics as we have it (those who do see a 'professional' and get correctly diagnosed). However I fail to see any reason for displaying pictures of particular events which are tangential at best. PTSD is an illness of the mind, therefore images of individual events that may or may not cause PTSD is next to useless. It would be better if the main pic was just not present at all, rather than lead people up the garden path with a misrepresentation. War may be one event, but doesnt affect everyone. Physical or sexual violence are just two causes, of which they do not guarantee an occurence of PTSD, therefore such imagery is inappropriate. Perhaps a graph would be better. On the lucretia issue, if Tom, you have patients (with PTSD) who have reported sexual violence as the cause, do you wave rape imagery in their faces? If not, why not? Because, quite simply, as you have said previously - an image of rape would not trigger someone with PTSD of which the primary cause was the rape.

Please use any image you feel is appropriate, providing you are thinking for those with the illness as well as for your own profession. — Preceding unsigned comment added by MagicalThinking (talk • contribs) 08:46, 3 November 2011 (UTC)

"Let us not forget that women are more likely to report psychological problems than men. However this is the statistics as we have it (those who do see a 'professional' and get correctly diagnosed)." Uh, no. My assertion about variable PTSD incidence comes right out of the article (I put it there!), and is well sourced. PTSD incidence data for the US is NOT based on self-report, nor on data from clinical settings, but rather from two large NIH catchment studies of the national population. Please check the article sources for more information.

As to the rationale for having imagery, and the difficulty of finding same, that's been well covered in previous discussion here. In summary, images make an article more attractive, and all the more so if they are relevant. The one we presently have is especially appropriate: it depicts a war scene (so says Goya), which is what people would incorrectly expect, but redirects us to the real problem, both in war and in society in general: traumatization not of male soldiers but of female civilians. I defy you to find a more fitting image. It does not mislead. Only a fool would expect an illustration to illustrate the whole phenomenon of PTSD. This one merely strikes to the heart of the causes.

You ask if I wave rape imagery in the face of a client who has rape derived PTSD...you bet I do, as that's how it's cured. But it's not some general image, or another person's image. It's whatever they retain in their mind from the traumatic event (which may well not be an image at all) which is still triggering posttraumatic stress. It is exposure to THAT, in a safe setting, which causes the brain to become disinterested, which thus terminates the triggering. This is precisely how the research indicates one should treat PTSD, and I do it, and it works. (Obviously this is done only under conditions of consent...)

I think it telling that the only two participants in this image discussion who are health care professionals, one a psychotherapist specializing in PTSD and other an emergency room physician who's seen plenty of trauma first hand, both found the Lucretia image acceptable and appropriate. It was the people who knew much less about the disorder who got all excited about it, for reasons that I never felt justified. Nevertheless, I think it worthwhile to find an image that is more acceptable to the general reader (for whom the article is written - not for the individual with PTSD - another common misunderstanding). The present image has garnered zero objections. And I still want to get that graph done, but will probably use it in the body of the article.

Thanks for your thoughts...Tom Cloyd (talk) 04:01, 5 November 2011 (UTC)

Quote "I think it telling that the only two participants in this image discussion who are health care professionals, one a psychotherapist specializing in PTSD and other an emergency room physician who's seen plenty of trauma first hand, both found the Lucretia image acceptable and appropriate. It was the people who knew much less about the disorder who got all excited about it" - amazing Tom - couldnt have put it more pompous and self-righteous myself. Doc James is a psychotherapist? No. So therefore his contributions are as valid as those who are equally qualified in the subject. Doc James self-reports he works in ER, not a psychiatrical setting, ergo whereas he may hail from a medical background, himself viewing people who have suffered trauma is no difference to those employed in the veterinary profession. And not a great deal different to Joe Public. (No offence to Doc James intended - I'm sure he is a capable medic). This is also not the first time you have decided to use language to insinuate nobody else is allowed to have a differing opinion to your own, almost akin to saying this - My name is Tom, I am a psychotherapist, if you are not then your opinion doesnt count - sounds a tad childish does it not? (I apologise if you find this offensive, however it is not intended as an insult, more of an observation over time - from experience). However, it is good you show such an interest in informing the public of your views, whereas it would appear most of your compatriots perhaps dont. However this is not your pet article - you cant protect it like its your property.

NB: Personally I believe the answer to a 'cure' to PTSD is talking about (re-living) the experience over and over, as more than likely the patient will not give away all information pertinent to the event at the first session, the progressive talking about, and re-living, the event diminishes the emotional effect over time, which leads to a more bearable state of mind (for the patient). I do not currently believe in a 'cure' per se, only treatment for a long term problem. Seriously though Tom, suggesting you have a 'cure' - do you mean a total cure? or just a (perhaps significant) improvement? As I say I believe currently that it (PTSD) can be improved, but not cured completed - a cure would suggest they had ASD. Anyway, the image was the first thing that one would see on this article as the eye is drawn to that which stands out the most, and the first thing you would do upon meeting a referral would not be to wave rape imagery in the face of those who had been raped, therefore the image was inappropriate. MagicalThinking (talk) 08:42, 17 November 2011 (UTC)

I know about PTSD because of [a] my formal training and [b] ongoing formal and self-directed continuing education activities, most of which focus on trauma-related disorders. As a physician, and especially as one specializing in ER work, Doc James is trained in general psychiatry (all docs have a psychiatric clinical rotation as part of their training). I'm sure that part of his continuing education training, which all physicians in the first world countries (and probably elsewhere as well) are required to have, involves refresher training in psychiatry. It is inconceivable to me that this might not be so. (I come from a medical family and so have some exposure to the life of a physician.) I do not think it unreasonable to claim that both of us have a significantly larger body of knowledge about the population of individuals affected by psychological trauma than does the general population (including vets, to whom you make reference). That's my argument, and it's fact based, not ego based.

Instead of addressing my argument, you attempt an ad hominem rebuttal. This is poor form, highly discouraged at Wikipedia (and in any other circles of educated people with which I am familiar), and irrelevant. You then attempt to construct what is in fact a straw man argument, by utterly mischaracterizing my position. Again, poor form, and irrelevant.

This IS my pet article, as I have put into it far more effort than anyone else (check the stats on this). That said, I clearly do not own it, and would never claim to. Instead, I have repeatedly asked others to engage in the hard work of scholarly effort to improve the article. Most people I approach turn me down. I see a lot of smoke here on the talk page, and not much fire. I suggest you learn a little about argumentation, as well as scholarly method, then consider working on the article. Be warned that, of course, I screen all edits (my user page says as much, right up front), and my standards are high. I doubt that any thoughtful person would find fault with any of that. I'm not pompous. I AM rigorous and demanding. So is the real world, where, if you don't have your facts straight you waste a client's time, take their money, and fail to deliver what they hope for and need. Psychotherapy is not a domain for the ill-informed, faint of heart, or dogmatic. It IS a domain for those willing to engage in continuous self-education, long hours of hard work, and the tackling of really hard problems.

A cure for PTSD? That would be an intervention which removes all clinical symptoms (my wording is very precise here) and substantially restores the client to their former level of function. I have brought this about many many times, as have others in my field. The popular press, and the US Veterans Administration, among others, has yet to fully catch up with this fact, which is well documented in the recent (last 15 years) research in the field. Don't reference your "belief". Neither your nor mine is relevant. The facts, as shown us both in the body of published clinical research on PTSD and the amalgamated clinical experience of thousands of trauma treatment psychotherapists, IS relevant. Psychotherapy is a science, not a religion. We don't have beliefs. We have knowledge, and techniques which are attempts to take advantage of that knowledge.

Finally, neither the Goya nor the Ficherelli is explicit rape imagery. Both are suggestive of it (one more than the other). That is appropriate for this article, as I have argued in considerable detail (without rational reply). Sexual assault, regrettably, is a part of our society, and mention of it is common found in our daily media. Images of it are fairly common in fine art. Such references may be challenging for sexual assault victims who have unresolved trauma memory. That's a signal that they have a problem, and should see resolution of the problem. That is my position, and I do think it is a reasonable one.

Tom Cloyd (talk) 20:11, 18 November 2011 (UTC).

Tom
I dont dispute your education, I do appreciate your input, as I'm sure a great many others do. Unfortunately I dont have the time to edit wikipedia (though I spend far too long rabbiting on here), although I can happily state the reason I have little input on this page is due to the fact I do not consider myself sufficiently informed on the entire subject to do so. This does not mean I should not be able to question the actions of those that consider themselves to be. Ergo I, and others, should be able to question whether or not a picture should be considered suitable. If the image on any article would be disagreeable to a potential reader, then it is likely they would find another source, or just not bother at all. Therefore it would be reasonable to consider more deeply the choice of picture for any article, or it is possible to end up with what we have - an (largely) ignorant public.

NB: The reason why referenced my belief was revelant to what I was trying to put across - however, as you correctly state beliefs are not fact.

However, this is an international site, and whilst you have data for the US, this is not worldwide. One (from the US) can easily assume everyone who reads the English version is from the US. However, I and many others are not (from the US), therefore data obtained purely from one country can be misleading. One can gather from worldwide figures of other mental problems, the occurence can alter significantly from country to country. As it is your pet project, perhaps you could obtain relevant data from other countries?

This means also I am not aware of the psychiatrical education of every, as you state, Doctor in the US. To what level I will not pursue. The fact is, and as I say - I do not wish to offend anyone - that although Doc James may have general psychiatrical training, it is still not at the same level as yourself, or any other psychotherapist, and therefore, although he may have more knowledge than the average Joe, he cannot be used as a backup.

Note: Please 'speak' to others as you would have them speak to you. Please do not imply they have no right to speak because they dont read the same magazine (journals) as you. They may not be from the same country for one.

The whole point is, is whilst it may be popular to have 'art' pics in US psychiatric journals, the average joe will be lucky if they know pop psychology. This is the average joe with 'IQ' of 90-105. No offense to any of them. Pop psychology mags will not have anything other than pics of so-called celebrities (media personalities), therefore they may find it difficult to understand why such images have been chosen.

NB: Whilst Tom truthfully states above that belief is irrelevant, I would like to point out that the above statement contains 'IQ', and it is my belief that IQ is worthless as an indicator of intelligence - half the score is relevant to certain skills (and not all encompassing), however part of this is due to education/general knowledge. Just as a note Tom - if you are now thinking I'm some sort of fool who disputes IQ test scores because it came out with a low score. For modesty I leave it out - you can form your own belief. Howevr, I have developed a system of correctly identifying potential intelligence, but it is ultimately flawed, somewhat less so than the current method.

By the way Tom, thanks for the input on the actual article - I have noticed it change for the better over the years, so keep up the good work. Just lessen the bad.

By the way, in science, belief pursued can turn into knowledge. This is called progress. Unless you are some sort of magical shaman?
~ — Preceding unsigned comment added by MagicalThinking (talk • contribs) 13:22, 22 November 2011 (UTC)

Article needs to be written based on secondary sources

For a major condition such as this it should be written based on secondary sources such as review articles and major textbooks per WP:MEDRS. Cheers Doc James (talk · contribs · email) 06:14, 20 January 2012 (UTC)

Always a welcome reminder, for those to whom this is an unfamiliar notion. Am in total agreement, of course, and am working on it as time can be found - be assured.Tom Cloyd (talk) 22:50, 31 January 2012 (UTC)

Medication

It states that "a variety of medicines are used to treat PTSS", but it does not state which ones. Please include a list of the most commonly used medicines. Also mention ketamine and psylocybine, even MDMA ; refs = http://www.maps.org/research/mdma/ , Hallucinogens as Medicine, Scientific American by C. Grob, R. Griffiths , The neurobiology of psychodelic drugs, Nature Reviews Neuroscience, september 2010 by F.X.Vollenweider, M. Kometer

91.182.173.66 (talk) 17:08, 24 February 2012 (UTC)

Are you allowed to edit Wikipedia if you have PTSD

[Content removed due to a complaint at my talk page].--20thtryer (talk) 16:43, 29 March 2012 (UTC)

Add reference?

• Psychological ‘Growth’ Through War and Disease: Sometimes It’s Just a Cruel Delusion by Gary Stix Scientific American April 1, 2012 99.181.147.96 (talk) 04:37, 2 April 2012 (UTC)

Nomenclature. PTS and PTSD

I am by no means an expert in this subject; however, while talking with a woman who specializes in PTS(D), she quickly told me that I should use the term Posttraumatic stress as opposed to posttraumatic stress disorder. She went on to say that the condition is not a disorder, but a natural reaction that should not be treated as an abnormality. I was wondering whether anyone has anything to say about this, and whether we should change this. Van Gulik (talk) 02:15, 29 March 2012 (UTC)

Agree with the name change. That is the direction it is going. I know the United States military, both the Army & the Marines are calling it PTS & I recommend we change the name of the article to match what you say. Semper Fi! FieldMarine (talk) 03:04, 30 March 2012 (UTC)

Posttraumatic stress is not the same thing as posttraumatic stress disorder. This article is about the psychiatrically recognized condition PTSD. Yes, people experience posttraumatic stress without all qualifying for a mental illness. Some, however, suffer so many symptoms and with such severity that they qualify for a mental illness, and their problem is what this article is about. Doczilla _STOMP! 00:30, 4 April 2012 (UTC)

OK, then I will create a separate article on PTS. Semper Fi! FieldMarine (talk) 01:39, 4 April 2012 (UTC)

• Comment. Why not discuss this in the article? I have been hearing of this in the media, and so there must be references that can be used. Posttraumatic stress redirects to Posttraumatic stress disorder. Since there seems to be discussion about this in the media, then this needs to be disambiguated in the lead section so that people coming to this page know the differences, if any, between the meanings of the two phrases. --Timeshifter (talk) 13:39, 23 May 2012 (UTC)

• We could direct the reader to an article or section addressing post-traumatic stress with a hatnote at the top of this article such as:

  This article addresses the psychiatric syndrome. For the common acute physiological and psychological response to trauma see Post-traumatic stress

or similar. This would necessitate someone writing that article/section, using WP:MEDRS quality sources, of course. A similar discussion was had regarding "Chronic fatigue" and "Chronic fatigue syndrome" a year ago here. --Anthonyhcole (talk) 05:50, 24 May 2012 (UTC)

Sounds like a good plan. The U.S. military already calls it PTS instead of PTSD, so there is plenty of sources available. Semper Fi! FieldMarine (talk) 14:56, 24 May 2012 (UTC)

I think both can be discussed in the same article if it does not make the article too long. On the other hand if 2 articles are needed then someone needs to be bold and remove the redirect from Posttraumatic stress, and start an article there. Here is the redirect page. --Timeshifter (talk) 18:38, 24 May 2012 (UTC)

I think that there is a tension between calling it a Disorder, and thereby tagging it as a Medical Condition worthy of concern, and on the other hand avoiding the word Disorder, and thereby avoiding the stigma of a Medical Condition &c... See the the end of the intro to the article [[peter chiarelli]. I conclude that PTS/PTSD are two names for it, and the degree of severity is perhaps obfuscatory (it is absurd in my understanding to say that someone with PTSD does not experience PTS, and likewise that someone who experiences PTS necessarily will not suffer it as a Disorder.) Furthermore, there is a history of renaming this disorder based on new paradigms: Soldier's Heart and Shell Shock, to name two. <http://www.pbs.org/wgbh/pages/frontline/shows/heart/themes/shellshock.html> Shall we merge those also into PTSD? And what about when in the future, doctors tell us about the next new name for it? I think that there's room in this big tent for every name, unless we want to split the History section into a new article. Mang (talk) 03:45, 23 October 2012 (UTC)

The term used in the ICD-10 is 'disorder'. The 'The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines' states 'The term "disorder" is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as "disease" and "illness". "Disorder" is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.'

To be honest, I like that wording.

With regards to the DSM-IV, "The task force that produced DSM-IV assumed, or asserted, that there is no fundamental difference between so-called mental illnesses or disorders and physical illnesses or disorders, and that the distinction between them is simply a relic of Cartesian dualism (American Psychiatric Association 1994). Others have taken the same view (Kendell 2001). If this view is retained, the fundamental issue is the meanings of the terms illness and disorder in general."

This is a good read about the use of the term here. (It's also where I got the DSM-IV quote from) Legios (talk) 06:31, 9 January 2013 (UTC)

Earliest Reports

The reference to Epizelus as an early example of PTSD is inappropriate: Epizelus suffered from hysterical blindness, which may or may not have been induced by psychological trauma, but certainly is not PTSD. If anything, it would be a symptom of acute stress disorder. If no one objects, this line should be deleted. Cmacauley (talk) 17:38, 4 February 2013 (UTC)

PTSD and ED

Hello!! I am student at the University of Florida and as part of my grade in one of my psychology courses our professor has assigned us to learn and participate in editing a wikipedia page. Because Wikipedia plays a vital role in disseminating psychological science to the masses. I would like to add a section on the connection found between Eating Disorders nd PTSD or perhaps it could go under the "Risk" section based on studies found in the Eating Disorders Review volume 23 Issue 6. Any input or help would be greatly appreciated!! - - Anajean93 (talk) 04:58, 2 April 2013 (UTC)

Hi Anajean93! I don't know very much about PTSD, and nothing at all about eating disorders and PTSD. However, one thing that is important to remember is that Wikipedia is not an academic paper or essay. Wikipedia articles should not be based on WP:primary sources, but on reliable, published secondary sources (for instance, journal reviews and professional or advanced academic textbooks) and, to a lesser extent, on tertiary sources (such as undergraduate textbooks). So if the article you mention is just a single study about this connection, there is a clear risk that it will be removed. However, if it is a review of several such studies, that seems to be a good addition to the article. WP:MEDRS describes how to identify reliable sources for medical information, which is a good guideline for many psychology articles as well. With friendly regards, Lova Falk talk 10:30, 14 April 2013 (UTC)

Gender differences

A section involving gender differences needs to be included. "Studies have shown that women are twice as likely to be diagnosed then men but they also tend to experience fewer traumatic events" --Hays, Elaine. "Will the Military Be Ready to Deal with PTSD in Women?." Policymic. N.p., 7 Feb. 2013. Web. 14 Feb. 2013. <http://www.policymic.com/articles/25163/will-the-military-be-ready-to-deal-with-ptsd-in-women>. — Preceding unsigned comment added by 64.112.206.6 (talk) 18:30, 19 April 2013 (UTC)

Hi 64.112.206.6! One source for a whole section on gender differences is probably not quite enough, but why don't you find good, secondary sources - and please also check WP:MEDRS - and then please be bold and write a section about it! With friendly regards, Lova Falk talk 17:12, 1 May 2013 (UTC)

DIAGNOSIS and TERMINOLOGY

I'm going to work on adding the ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines for PTSD in to the DIAGNOSIS section as well as a comparison of ICD-10 vs. DSM-IV criteria. I'll also put together some notes on the use of post-traumatic vs. posttraumatic for updating TERMINOLOGY.

I won't make any changes to TERMINOLOGY because I can see it'll be contentious, but will update this section with my research. Legios (talk) 02:32, 9 January 2013 (UTC)

Cool. Be sure that what you add is supported by sources that conform to this guideline: Wikipedia:Identifying reliable sources (medicine), and don't draw any conclusions that aren't drawn in the sources themselves, per Wikipedia:Original research#Synthesis. --Anthonyhcole (talk) 04:21, 9 January 2013 (UTC)

I've added the diagnostic and assessment criteria for PTSD as defined in the ICD-10 (and the 'Blue Book'). Someone may wish to clean it up though. Legios (talk) 09:26, 8 May 2013 (UTC)

To achieve A-Class status for article: proposed edits/amendments - 2011.02.23 edition

[Note: I am reviewing this entire section, in preparation for resuming work on the article. Tom Cloyd (talk) 22:52, 23 February 2011 (UTC)]

Proposed article structure revision

Sources

As of 2010.03.27, the article's structure is still under review. I am examining the following sources to ensure that the structure is at least adequate (which will not be my terminal goal, however!):

1. major reviews of this disorder in current books and journals articles by respected experts;
2. similar articles published online;
3. material similar to nos. 1 & 2 of or major mental illness diagnoses;
4. recommendations in various Wikipedia sources, such as (and these are only examples): Wikipedia:The perfect article and Wikipedia:Layout.

Working draft

To promote transparency, and comment, I place here my current working draft for the revised article structure. As it's a work-in-progress, it may well be incomplete, to some readers' eyes. If so, do comment. Thanks!

• Diagnosis
  • Criteria in current use (compare ICD-9, -10, and DSM-IV)
  • Research-based alternative conceptualizations
  • DSM-V proposed diagnostic criteria changes
  • Problems: Misdiagnosis and underdiagnosis
• Causes and risk/protective factors
  • Current state of analysis of causes of PTSD
  • Psychological trauma
  • Neurological factors
  • Genetics and gender (split into separate sections?)
  • Developmental, sociological, and cultural factors
• Treatment
  • Prognosis
  • Pre-treatment prevention
  • Early intervention
  • Psychotherapeutic treatment
  • Pharmaceutical management of symptoms
• Epidemiology
  • Prevalence
    • International PTSD rates
    • United States
    • In other species
  • Comorbidity
    • Substance abuse
    • Depression
    • Personality disorder
    • Panic disorder
  • Disease impact
• Public policy response
• History of the disease concept
• Notes
• References
• Recommended reading
• External links

Rationale for the Notes/References distinction - notes

• Alternative system (for citation organization)

• Wikipedia Layout: Standard appendices and footers > Notes and References

Rationale for the Recommended Reading section - notes

Wikipedia Layout: Standard appendices and footers > Further reading

List of specific tasks

I have revised this completely; revisions will continue, as I work through the list. This is intended to be prioritized list of tasks to be completed to bring this article's quality up to A-Class candidacy. I enthusiastically invite additions to this list which may help achieve this goal. Given the endemic under-diagnosis of this very serious disorder, with a consequence across-the-board failure to treat many if not most people who have it, getting quality, correct, accessible information into this prominent article is a legitimate priority for us.

As list items are completed, I'll move them to a similar list in the Talk page archive.

Priority indicates the approximate order in which I'm addressing each issue.

Priority (1-2-3)	ISSUE: Proposal(s) / Status
---	"REFERENCE NOTES" section - Proposal PROBLEM: Too many references are (a) of poor or uncertain quality, (b) or are unverifiable (for example, television shows), or (c) not backed up by use of secondary sources. Some link to online sources that have no author or date (and thus no credibility), or are simply the wrong sources for the citation. SOLUTION: As each section is reviewed, verify all citations, locating better ones where needed. Status of citation verification, by article section (Using section titles as of 2010.04.06) - reviewed 2010.04.06 Introductory summary: to be done Diagnosis: 90% complete Causes: to be done Prevention: to be done Management: to be done Prevention: to be done Psychotherapeutic...: to be done Medication: 95% Epidemiology: 98% complete History: to be done
3	INTRODUCTORY SUMMARY section - Proposal PROBLEM: Summary does not neatly provide summary of each major section, which IS possible, if each section is well written. SOLUTION: When all article sections are revised, review and revise summary to succinctly reflect this work. Status - reviewed 2010.03.26 to be done
2	"CAUSES" section - Proposal PROBLEM: This section badly mixes up causes with correlates, and in so doing simply confuses more than it informs. E.g.: no one at all well informed about PTSD seriously thinks neuroanatomy is a cause of PTSD. It may be a factor which increases vulnerability, but that's not what's stated. There's some good material here, but not well organized or written. (see discussion below) SOLUTION: Locate highest quality research and review references, and rewrite this section to summarize their content. Status - reviewed 2010.03.26 to be done
1.1	"DIAGNOSIS" section Proposal PROBLEM: There's nothing here about differential diagnosis. Also, this section is currently USA-centric, in that it reflects only one of the formal diagnostic criteria sets in use today - the DSM. SOLUTION: Add brief section covering differential diagnosis; create a table comparing DSM-IV and ICD-10 diagnostic criteria. Status - reviewed 2010.03.26 to be done
1.3	"PREVENTION" section - Proposal PROBLEM: This material is actually about National policy regarding the problem of PTSD. SOLUTION: Re-conceptualize, and re-title this section. Locate additional material about national policy (including with the UN, if possible). Especially important: Too much material addresses less than one-third of the problem: men. More than two thirds of the people with PTSD are women. What, if anything, is being done at national levels to address this population segment? Status - reviewed 2010.03.26 to be done
1.2	"MANAGEMENT" section - Proposal PROBLEM: This is a highly unfortunate and inappropriate term. We don't "manage" PTSD; we TREAT it. Complex (as opposed to ordinary) PTSD rather often cannot be completely resolved, and in that case there ARE management interventions which are appropriate. PTSD may also need to be "managed" until appropriate treatment can be arranged, for various logistic reasons. The core problem here is that significant numbers of the lay public, and too many health professionals as well, appear unaware that PTSD is highly - repeat, highly - treatable. This is a clinically verified and wholly supportable assertion. Many people, including far too many professionals in the US Veterans Administration (and surely equivalent organizations in other countries), settle for "management" when they could and should be insisting on treatment, in which PTSD symptoms are fully resolved by the end of treatment. Again, the only controversy about this derives from not being familiar with readily available relevant research literature. SOLUTION: I will be restoring a "Treatment" section, with a management sub-section addressing when management is appropriate. I will make certain that this section fully supports the assertions I have just made (not a difficult job). Status - reviewed 2010.03.26 to be done
1.0	"EPIDEMIOLOGY" section - Proposal PROBLEM: The coverage of the distinct gender differential in PTSD is not adequately addressed. Good references on this are readily available (and in hand). SOLUTION: Add well-sourced material to address this deficit. Status - reviewed 2010.03.26 to be done
2	"HISTORY" section - Proposal PROBLEM: The accuracy of all information here is completely unverified. Some of the sources seem close to "pop culture" quality. We can do better. In additions, it's been proposed that the "Gulf War Syndrome" is relevant to the modern history of PTSD. SOLUTION: Review all cited sources. Research "Gulf War Syndrome" for possible inclusion in article. Rewrite section as needed. Status - reviewed 2010.03.26 to be done
3	TERMINOLOGY - "posttraumatic" vs. "post-traumatic" Proposal PROBLEM: English is increasingly the international language of research science. Psychology is a science. PTSD is referred to officially as post-traumatic stress disorder in most contexts outside of the USA-related English speaking world. It therefore seems needlessly, and even offensively, USA-centric to retain the terms preferred only by the American Psychiatric Association. SOLUTION: Research this further and see if a sound case can be build for converting this article to accepted international usage. If so, change the convention here, and propose its change anywhere else in Wikipedia where it may seem advisable. Status - reviewed 2010.03.26 to be done

Reactions? Please reference proposed changes by its capitalized short title in table above... TomCloyd (talk) 11:59, 24 August 2009 (UTC)

Comments

Reaching for A-Class status

We do not have a specific A class system at WP:Med therefore recommended GA as the next step.Doc James (talk · contribs · email) 08:14, 1 January 2010 (UTC)

Well, heh heh, as a psychotherapist, I find myself unconcerned about this :). PTSD is a disorder of the adaptive, learning brain, and has never seriously been considered to be a disorder of primarily organic origins. It is therefore is a problem for the psychological community to address, primarily. Psychiatry has contributions to make to our attempts to deal productively with PTSD, to be sure.

It occurs to me that an analogy could be drawn to questions of inadequate intellectual performance in school exams, which we know can be improved - in general, about 10% - by ingestion of moderate amounts of caffeine. So, does this make education a medical issue, to be brought in under the purview of "medicine", because we have a drug for the problem? (I just thought it would be wonderful to start the new year with a minor controversy!)

As to your specific proposal, you and I have already discussed your idea elsewhere, and I think it has real merit. My primary concern, however, is simply to improve the quality of this article, an idea with which few people will disagree, I imagine.

TomCloyd (talk) 05:42, 2 January 2010 (UTC)

Problem of attribution of causality

A good summary. To your list of 'CAUSES,' which you say risks confusing causes with correlates, I would add the following from the current draft: "In addition, encountering or witnessing an event perceived as life-threatening such as ... drug addiction." Addictive behavior is more often the result of individuals suffering from PTSD who are self-medicating.

Couldn't agree more. My plan is to basically rewrite this whole section, using only the most solid of references. I just need a little time to organize it. I'll soon be free to tackle this. TomCloyd (talk) 21:54, 15 September 2009 (UTC)

There are many Wikipedia pieces which begin on the right path, but after users have appended (sometimes tangential) information, end up being useless because they're so watered down. It would be nice if this piece were the exception. So I agree with your targeted approach. I suggest taking a sharp scalpel to things which aren't necessarily linked -- or, as you say, are correlates, or simply psychological fallout from PTSD, like addictive behaviors, instead of the causes themselves.Regards, MarmadukePercy (talk) 06:02, 14 September 2009 (UTC)

Precisely my thinking and intention. Thanks for the support. PTSD treatment is my professional specialty. I want this article to be as good as it can be, for the sake of those who read it who really need accurate information. They deserve no less.

I am developing the habit of checking it almost daily, as well, and will continue to do so for the foreseeable future. There are too many passersby who think this is a good place to post opinion - theirs. Not so! TomCloyd (talk) 21:54, 15 September 2009 (UTC)

I certainly agree that much of the information under the 'CAUSES' section - particularly the biological findings - aren't true primary causes, and are better described as correlates, risk factors or possible diatheses. However, much of this information is important and should still be included in the article. One solution would be to group neuroanatomy, neuroendocrinology, and genetic under a new section ("Biology" or similar), and to make "Risk and Protective Factors" a stand-alone section. This would leave only the "Psychological Trauma" subsection under "Causes." The new "Causes" section could be expanded to include a description of psychological and biological processes hypothesized to be directly involved in PTSD pathogenesis (e.g., the development of cognitive biases in response to trauma; insufficient containment of the stress response by glucocorticoids immediately after trauma). Zefryl (talk) 04:32, 26 September 2009 (UTC)

"Causality" is, of course, a tricky subject, in general. The problem in any particular case, I think, is to write in a way that respects the formal difficulty of causal analysis while yet conveying useful content to the lay reader. I'm thinking we might use a distinction such as "primary causes" and "risk factors" (per your suggestion), would probably be fairly clear to most readers, even it it is not entirely satisfactory (to me, at least). I appreciate your detailed comments on this. It's great to see that I'm not alone in having major issues with this section. I should very soon be out from under the professional pressures by which I'm currently constrained, at which point I will get out a revision. I hope we can the chew on it together and whip it into shape.TomCloyd (talk) 22:05, 29 September 2009 (UTC)

Terminology

I know there's been discussion around posttraumatic vs. post-traumatic. The question/issue proposed was "SOLUTION: Research this further and see if a sound case can be build for converting this article to accepted international usage. If so, change the convention here, and propose its change anywhere else in Wikipedia where it may seem advisable."

The ICD-10 "Blue book" (The ICD-10 Classification of Mental and Behavioural Disorders) lists it as "Post-traumatic stress disorder" http://www.who.int/classifications/icd/en/bluebook.pdf

I'm not trying to kick up a storm here, but additional research was wanted and that's how the ICD-10 defines it, which is different from the DSM-IV listing it as "posttraumatic stress disorder". The DSM-IV whilst used internationally is also defined by the APA, whereas the ICD-10 is defined by the WHO which (IMHO) represents a more global audience.

I'm sure to get some colourful responses but decided to kick the hornets nest. :)

Legios (talk) 14:45, 10 May 2013 (UTC)

NPOV flagged in "Eye movement desensitization and reprocessing" section

[NOT ARCHIVED - is an unresolved issue to which response is needed. Tom Cloyd (talk) 00:17, 24 February 2011 (UTC)]

The problem is the source. Two of the primary authors are major critics of EMDR; the summary given in the article is their POV, which is not necessarily supported by research done after that cited in the source document. We need to do a more balanced review of the research before launching a summary of the sort offered here. (I'm trained in EMDR, and while in no way a flag carrier for the sometimes overly zealous EMDR establishment, am aware of this more recent research. It is not reflected here, and probably should be.) Tom Cloyd (talk) 10:17, 26 April 2010 (UTC)

There are some discussions about EMDR vs. PE (Prolonged Exposure) therapy that would be good to discuss here. http://www.ncbi.nlm.nih.gov/pubmed/16382428 and http://www.ncbi.nlm.nih.gov/pubmed/17990196

I'm purely bringing them up as points of discussion.

Thoughts?

Legios (talk) 15:09, 10 May 2013 (UTC)

It seemed to me to be a clashing mix of two points of view. I've been carefully through the latest systematic reviews: I think I've summarized it neutrally. I also think it needed an explanation of what this therapy is - pulled in some of the points made about this in the Francine Shapiro page, but struggled a little to give an explanation of the technique - a little video would be help, and I'm sure there are better ways of describing it. I checked the 2 studies raised here: both were assessed by the systematic reviews cited now. Hildabast (talk) 01:49, 6 June 2013 (UTC)

NO HYPHENS in "Posttraumatic..." PLEASE

(NOTE: this is a summary of the talk page section of the same title now in the [2009 archive]; please see that section, which is first on the page, for full details.]

[ADDITIONAL NOTE - this spelling issue is a chronic one. This talk page section is here to try to reduce the amount of repetitive correction the article maintainers have to do. Please do not remove or archive this section. It will be needed for the foreseeable future. Thank you!]

Current convention in this article is to follow the spelling adopted some time ago by the Diagnostic and Statistical Manual of the American Psychiatric Association, and use the term posttraumatic (no hyphen) rather than post-traumatic. There is currently a proposal to change this convention, but for now please hold to it, lest chaos be introduced here. It's confusing to readers to see two different spellings in the same article.

To read the proposal for changing the spelling, see [To achieve A-Class status for article], below - specifically the proposal titled TERMINOLOGY, dated 2010.01.01.

TomCloyd (talk) 08:57, 2 January 2010 (UTC)

Agree but we do not need half a dozen tags in the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:24, 8 June 2013 (UTC)

New image for the lead

File:A mask, painted by a Marine who attends art therapy to relieve post-traumatic stress disorder symptoms, USMC-120503-M-9426J-001.jpg

A mask, painted by a Marine who attends art therapy to relieve post-traumatic stress disorder symptoms

This image has been proposed for the lead. Peoples thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:38, 2 June 2013 (UTC)

Created by someone affected by PTSD, and it says something about the condition. An improvement over the not-very-appropriate Goya image. Cmacauley (talk) 22:34, 2 June 2013 (UTC)

How about for this section of the article? New worl (talk) 06:36, 8 June 2013 (UTC)

I like it as the main image because even though it's done by a person with military trauma (presumably alone, but not necessarily - could have had PTSD before military, could be MST, etc), the image itself is not specific to a trauma - it's about the actual condition. Nor is the actual image gender-specific and it blurs racial lines a bit. Like Cmacauley, I like that it's created by a person with PTSD. Hildabast (talk) 11:59, 8 June 2013 (UTC)

Okay switched images. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:12, 8 June 2013 (UTC)

DSM-5 criteria?

Someone added the proposed criteria for DSM-5 to the top of the article, can anyone confirm they're official? Also criteria for PTSD in children under 6 years of age seem to be missing. Can anyone with the book confirm any of this and format it properly? --94.37.80.83 (talk) 17:39, 9 June 2013 (UTC)

Shouldn't be at the top of the article. It is dealt with lower. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:41, 9 June 2013 (UTC)

Sorry to have put them at the top of the article, especially as I had already added them below. A mind fart, I guess. I have DSM-5 and what I added is accurate. I just ran out of steam when it can to adding the criteria for children under 6 years of age. Got too tired to do it! Best wishes, Farrajak (talk) 00:05, 10 June 2013 (UTC)

I've further reduced the section on diagnosis in the introduction, because there were contradictions between intro, classification and diagnosis, and this is a start to reducing the problem. Hildabast (talk) 23:58, 9 June 2013 (UTC)

In DSM-5, PTSD is a Trauma- and stress-related disorder and is no longer an Anxiety disorder

A new category has been created for those disorders that explicitly list in their criteria exposure to a traumatic or catastrophic event. Farrajak (talk) 01:33, 10 June 2013 (UTC)

New section on "other" management begun (with exercise)

I've added sport/exercise/physical therapy as the first "other" in management. I've added some ongoing trials and have set myself up an alert to see when these are published, so that I can keep this up-to-date. As an option that is stigma-free and you can do-it-yourself, I thought it was important to add even though the evidence isn't strong yet, and there's lots unknown with the intervention anyway - does it make a difference if you do it outside, does doing it in a team make it better or worse and so on. As the category "other" expands, it may need additional sections, but since I added just a few lines on this, I didn't think that made sense at this stage. I've started jotting down candidates to gradually get added, and will pull together a list to post here, sooner rather than later, I hope. Suggestions very welcome. Hildabast (talk) 18:16, 8 June 2013 (UTC)

Have now added play therapy for children and adolescents. Hildabast (talk) 03:25, 11 June 2013 (UTC)

Australian news report

Some interested editors may want to include some of this Australian news report in the article. Afterwriting (talk) 05:26, 16 July 2013 (UTC)

Service dog material

None of the proposed sources appear to meet WP:MEDRS requirement for sourcing. This is a project proposal, this is a popular press article, this is a random compendium of primary article with no analysis, this and this appear to be a primary research article and letter to the editor respectively, and as far as I can tell don't even talk about service dogs. None of these appear to meet WP:MEDRS requirements. Yobol (talk) 19:17, 22 July 2013 (UTC)

I understand. (and I apologize for doing it incorrectly). Can you help me find an article that would be appropriate? It seems like the use of service dogs would warrant mention? Zipster969 (talk) 19:23, 22 July 2013 (UTC)Zipster969

Service dogs

With all the mention in the NY Times and other non-WP-MEDRS-approved (but legitimate) secondary sources, and the primary peer-reviewed studies showing the effectiveness of service dogs for PTSD is there not at least one WP.-MEDRS approved secondary review article that we could use to bring up the topic? -Zipster969 (talk) 19:20, 22 July 2013 (UTC)Zipster969

I've run a sensitive PubMed search and consulted the TRIP database (as well as PubMed Health). The only two possible MEDRS sources I was able to find there are PMID 22388677 (to which, unfortunately I don't have access) and this "rapid review". I also did my best to look at Google Books: see [1]. 86.161.251.139 (talk) 20:13, 22 July 2013 (UTC)

Those are great resources. Thank you! 98.240.251.21 (talk) 00:40, 23 July 2013 (UTC)Zipster969

Unfortunately, the 2 papers used to support statements of proof of effectiveness don't. The second one is about validity of a survey instrument - was this an error? I couldn't find anything on dogs in it. If I overlooked something, let me know. The first one is a cross-sectional study in 9 girls that lasted only 3 months, without a comparison group: that kind of study can't prove effectiveness. The review reports what it found in those girls, but for a few reasons that doesn't mean it proves what's stated: that kind of study couldn't prove their improvement was because of the dogs and not just normal recovery (or that something else had helped), and three months from the trauma is too short a followup. Hildabast (talk)

I couldn't find any trials on this subject. But I don't think the lack of proof of effectiveness means that there can't be a section on dogs - it just can't claim that it has been proven to help, and it doesn't belong under CBT, because dogs are not cognitive-behavioral therapy. This information from the VA talks about the potential benefits of dogs (emotional support, fun), potential harm (keeping people at a distance, the person thinking they don't need help other than the dog, that they are reliant on the dog), the dog's need for good care, and the importance of not thinking a dog replaces the need for evidence-based treatment. There's a section "Other" 6.3: I think a paragraph there, based on this VA information, would be great. It's not research, but it is a reasonable expert-based source, given there is no research proving effectiveness. The CADTH study could be included, but not to prove effectiveness: to say something general about dogs being studied, but there not being enough research yet. I'd really encourage you to write a para there. Hildabast (talk) 02:15, 23 July 2013 (UTC)

This seems to me an eminently sensible suggestion. The Veterans Association information sheet [2] is an excellent find. Its introductory section prominently states that "Evidence-based therapies and medications for PTSD are supported by research. We encourage you to learn more about these treatments because it is difficult to draw strong conclusions from the few studies on dogs and PTSD that have been done." Personally, I don't support citing the CADTH rapid review: it reaches some pretty uncritical generalized conclusions regarding recorded claims of improvements in mental function, quality of life and socialization across the board (although it does urge for caution). I agree with Hildabast that it should not be considered a reliable medical source in support of effectiveness, and I feel that its inclusion could be a source of confusion to users who verify page sources. 86.161.251.139 (talk) 08:23, 23 July 2013 (UTC)

Posttraumatic stress disorder litigation

It should be said that victims of Posttraumatic stress disorder have the right and even the obligation to take their cases to court and address the causes of their condition. — Preceding unsigned comment added by 96.26.56.220 (talk) 01:30, 30 July 2013 (UTC)

Edit request on 7 August 2013

Specific description:

Please, in PTSD or Posttraumatic Stress Disorder, add the full reference 78. Up to now you see only the follwing link for that reference: http://www.nature.com/emboj/journal/v30/n19/full/emboj2011293a.html

This is the complete info for that reference.

Neuroepigenetics (talk) 11:39, 7 August 2013 (UTC)

Done. Thanks. Sarahj2107 (talk) 15:20, 9 August 2013 (UTC)

PTSD Treatment Using Madical Marijuana, controversial, should include a reference to

The article Medical marijuana cites Ganon-Elazar E, Akirav I (2009). "Cannabinoid receptor activation in the basolateral amygdala blocks the effects of stress on the conditioning and extinction of inhibitory avoidance". J. Neurosci 29 (36): 11078–88. doi:10.1523/JNEUROSCI.1223-09.2009 as one of its references, but there are others. It is a controversial treatment option as noted in "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942910/". US Government (Military/Veterans Affairs)research notes significant PTSD patients self-medication using Marijuana. 184.76.59.220 (talk) 05:23, 7 September 2013 (UTC)

Looking for someone to nominate this article for GA status

Does anyone else think this article is up to GA status?--Bigpoliticsfan (talk) 23:58, 13 November 2013 (UTC)

Hi Bigpoliticsfan! I don't have the time to seriously consider your question, but just a quick comment. There are two clarify-tags in the article and these issues need to be addressed first. Also the section Psychological debriefing needs some copyediting to make it more coherent. Lova Falk talk 09:29, 2 December 2013 (UTC)

Pathophysiology mistakes

Please correct these (I am not yet confirmed here). "When someone with PTSD undergoes a stimuli similar to ..." the singular form is stimulus not stimuli. "The medial prefrontal cortex, part of the amygdala, can inhibit the conditioned fear responses during trauma." The mPFC is definitely not part of the amygdala, neither is the opposite true (amygdala being part of the mPFC). The amygdala belongs to the medial temporal lobe, not PFC. "High levels of cortisol reduces noradrenergic activity it is proposed that individuals with PTSD fail to regulate the increased noradrenergic response to traumatic stress." This sentence makes no sense. — Preceding unsigned comment added by Bhut Jolokia (talk • contribs) 16:49, 18 November 2013 (UTC)

Hi Bhut Jolokia, and thank you for your comments! I changed "a stimuli" into "stimuli", copyedited and then removed the sentence about mPFC and amygdala (because the text was repeated in another sentence) and added a {{clarify}} tag to the sentence that makes no sense. A tip for you: if you're unsure, you can always see if you can read the source that is given. With friendly regards, Lova Falk talk 09:55, 2 December 2013 (UTC)