Traumatic stress disorders: a classification with implications for prevention and management.

The management and prevention of acute and post-traumatic stress disorders are current themes of great importance to the defense health services of many nations. Currently, between 2% and 8% of service members deployed on combat operations, United Nations peacekeeping tasks, and humanitarian and disaster relief operations present with one or more stress disorders within 3 years of deployment. The management of acute stress disorders and the prevention and management of post-traumatic stress disorders necessitate an understanding of the nosology of this group of illnesses. Research into some preventive options--such as critical incident stress debriefing--also necessitates the selection of syndrome-specific subjects during case finding if controversies about the efficacy of such interventions are to be resolved. Diagnostic features, a summary of the nosological evolution, and key points of differential treatment options are presented for 5 acute operational stress disorders (acute combat stress disorder, conversion reactions, the counter-disaster syndrome, peacekeeper's acute stress syndrome, and the Stockholm syndrome) and for 11 post-traumatic disorders, including classic post-traumatic stress disorder, chronic fatigue syndrome, Gulf War syndrome, peacekeeper's stress syndrome, survivor's guilt syndrome, and the syndrome of lifestyle and cultural change.