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priate scientific literature relating to the development of psychological dysfunction as a result of exposure to environmental toxins or experiences in chemical and biological warfare environments. Although the amount of scientific literature in this narrow area of focus was found to be quite small, it can be assessed against the background provided by intensive research into PTSD and other stress-related syndromes.

This chapter begins with a description of the historical development of the concept of PTSD. It also relates the findings from the literature and places those findings in context with what is known about the chemical warfare testing programs in WWII. Finally, this chapter outlines the committee's conclusions on the likelihood of adverse psychological health effects from exposure to mustard agents and Lewisite, particularly exposures such as those experienced in WWII testing programs.

The emphasis is on PTSD because the majority of work on the psychological sequelae of "war" experiences, such as those experienced by veterans contacting this committee, emphasizes PTSD. In this context, depression and anxiety are most often considered to be part of a constellation of psychological and psychiatric symptoms that comprise PTSD. In addition, mood disorders (e.g., major depressive disorder, bipolar disorder, and dysthymia) and anxiety disorders (e.g., generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobia) can also occur independently or as diagnostic entities coincident with PTSD (defined as comorbidity).

The precise definition of PTSD comes from  the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), 3rd Revised Edition (DSM-III-R, 1987; Box 11-1). The DSM is constantly undergoing revision by panels of experts who reexamine each diagnostic category and refine definitions and criteria based on the latest research data. It is also important to note that the diagnostic categories must be broad enough to cover PTSD caused by combat stress, sexual abuse and violence, environmental disasters, and many other types of stress. In addition, the exact combination of symptoms may also be dependent on age, gender, and other variables. At present there are four diagnostic criteria for PTSD:

  •  the existence of a recognizable stressor that would evoke significant symptoms of distress in almost anyone and is outside the range of usual human experience;

  •  reexperiencing of the trauma and intensification of symptoms with exposure to events that symbolize or resemble the traumatic event;

  •  numbing of responsiveness to, or reduced involvement with, the world, beginning after the trauma and including avoidance of activities that arouse recollection of the traumatic event; and



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