Editor, – I refer to the excellent article on post-traumatic stress disorder (Aust Prescr 1999;22:32-4). As the authors note, it took millennia for the disorder to be formally recognised. I wonder how long it will be before persistent duress stress disorder (PDSD) is recognised. This disorder carries exactly the same features as outlined in Table 1 of the DSM-IV criteria, except there is no single traumatic event.
Many cases of so-called shell shock or battle fatigue resulted from persistent duress, especially during World War I (compared to World War II) when trench warfare was the main tactic. During Vietnam, tense jungle patrolling without many contacts was the main issue. There is no doubt that many refugees and other victims of the threat of violence, as much as violence itself, suffer PDSD. Often there is no opportunity for sufferers to adapt: the stressors are persistent and unrelenting, and there is no escape.
Unfortunately, our governments have demanded that we ascribe the symptomatology to single traumatic events. As a profession we cravenly comply, thus being iatrogenic contributors to the disorder.
Even though the disorder is simply treated early enough in its genesis just by separating patients from their stressors, if possible, PDSD is not politically acceptable, because governments, large employers and compensation underwriters(the last at great cost to us all) all have a stake in not recognising it. For example, in a report from Griffith University a few years ago, the authors estimated that workplace bullying cost the Queensland Government $2.2 billion annually.
PDSD is thus a major public health issue, carrying considerable, perhaps immeasurable morbidity and cost. It is capable of affecting whole families, groups and even organisations (there is considerable management literature about organizational dysfunction which is the principal aetiology of much PDSD).
Maarten de Vries
MDV Leadership and Management