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'''Post-traumatic stress disorder (PTSD)''' was not recognized as a disease until 1980, when the American Psychiatric Association created a new classification of disease.<ref name="dsm1980">{{REFbook |last=American Psychiatric Association |first= |year=1980 |title=Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) |url= |pages= |isbn= |accessdate=2021-08-08 }}</ref><ref name="vanderkolk2014A">{{REFbook |last=van der Kolk |first=Bessel |init=BA |author-link=Bessel van der Kolk |year=2014 |title=The Body Keeps the Score |url= |page=19 |isbn=978-0-14-312774-1 |accessdate=2021-08-07 }}</ref> Prior to that time, the condition was variously called ''shell [[shock]]'' or ''combat fatigue''. The following text is quoted from the [{{WikipediaQuote|URL=https://en.wikipedia.org/wwiki/index.php?Post-traumatic_stress_disorder|title=Posttraumatic_stress_disorder Wikipedia]:Post-traumatic stress disorder}}
<blockquote>
'''Posttraumatic Post-traumatic stress disorder''' ('''PTSD''') may develop after a person is exposed to one or more traumatic events, such as major stress, sexual assault, terrorism, or other threats on a person's life.<ref>American Psychiatric Association (2013). ''Diagnostic and Statistical Manual of Mental Disorders '' (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–280. ISBN 978-0-89042-555-8.</ref> The diagnosis may be given when a group of symptoms, such as disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event.
Most people having experienced a traumatizing event will not develop PTSD.<ref>National Collaborating Centre for Mental Health (UK) (2005). [https://www.ncbi.nlm.nih.gov/books/NBK56494/ "Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care"]. NICE Clinical Guidelines, No. 26. Gaskell (Royal College of Psychiatrists). [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015848/ Lay summary] – Pubmed Health (plain English).</ref> People who experience assault-based trauma are more likely to develop PTSD, as opposed to people who experience non-assault based trauma such as witnessing trauma, accidents, and fire events.<ref>Zoladz, Phillip (June 2013). "Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature". Neuroscience and Biobehavioral Reviews 37 (5): 860-895. https://dx.doi.org/10.1016%2Fj.neubiorev.2013.03.024</ref> Children are less likely to experience PTSD after trauma than adults, especially if they are under ten years of age. War veterans are commonly at risk for PTSD.
</blockquote>
===Child circumcision as a traumatizing eveɲtevent===When an infant boy is to be [[circumcised]], it is the usual practice to immobilize the infant for the [[Pain| painful]] surgery by securely tying his limbs to a molded plastic board specially made for that purpose called a [[circumstraint]]. The infant thus is preventing from fighting or fleeing, which is the [[trauma]]-producing situation of ''inescapable [[shock]]'', described as a "''physical condition in which the organism cannot do anything to affect the inevitable''."<ref name="vanderkolk2014B">{{REFbook |last=van der Kolk |first=Bessel |init=BA |author-link=Bessel van der Kolk |year=2014 |title=The Body Keeps the Score |url= |page=76 |isbn=978-0-14-312774-1 |accessdate=2021-08-12 }}</ref>
The male [[circumcision]] operation to amputate the [[foreskin]] has been shown to be a traumatic event. Taddio & colleagues (1995)(1997) studied the effect of neonatal circumcision on the behavior of boys after surgery and at the time of vaccination. It was found that [[circumcised ]] boys had a higher pain response at time of vaccination six months later as compared with [[intact ]] boys,<ref name="taddio"1995">{{REFjournal |last=Taddio |init=A |first=Anna |author-link= |last2=Goldbach |init2=M |first2=Morton |author2-link= |last3=Ipp |init3=M |first3=Moshe |author3-link= |last4=Stevens |init4=S |first4=Bonnie |author4-link= |last5=Koren |init5=G |first5=Gideon |author5-link= |TaddioA etal=no |title=Effect of neonatal circumcision on pain responses during vaccination in boys |journal=Lancet |location= |date=1995 |volume=344 |issue= |pages=291-2 |url=http://www.cirp.org/library/pain/taddio/ |archived= |quote= |pubmedID=7837863 |pubmedCID= |DOI=10.1016/s0140-6736(95)90278-3 |accessdate=2020-11-10}}</ref> <ref name="taddio1997">{{REFjournal |last=Taddio |init=A |first=Anna |author-link= |last2=Katz |init2=J |first2=Joel |author2-link= |last3=Ilersich |init3=AL |first3=A. Lane |author3-link= |last4=Gideon |init4=K |first4=Koren |author4-link= |etal=no |title=Effect of neonatal circumcision on pain response during subsequent routine vaccination |journal=Lancet |location= |date=TaddioA KatzJ IlersichAL KorenG 1997-03-01 |volume=342 |issue=9052 |pages=599-603 |url=https://yorkspace.library.yorku.ca/xmlui/bitstream/handle/10315/7941/KAT036.pdf?sequence=1&origin=publication_detail |archived= |quote= |pubmedID=9057731 |pubmedCID= |DOI=10.1016/S0140-6736(96)10316-0 |accessdate=2020-11-28}}</ref> showing that the nervous system had been permanently sensitized to heightened pain sensation.
Taddio ''et al''. (1997) concluded:
<blockquote>
Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as [[pain]]. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.<ref name="taddio1997" />
</blockquote>
John Rhinehart, M. D., (1999) a clinical psychiatrist, reported finding numerous cases of [[PTSD ]] in his adult male patients pursuant to infant circumcision.<ref>{{REFjournal
|last=Rhinehart
|first=John
|init=J
|author-link=
|title=Neonatal circumcision reconsidered
|url=http://www.cirp.org/library/psych/rhinehart1/
|accessdate=2020-11-28
}}</ref>
Boyle & Ramos (2019) studied boys in the Philippine Islands who had undergone medical circumcision and others who had suffered the traditional "''tuli''" circumcision. Of the boys who had a medical circumcision, 51 percent exhibited symptoms of [[PTSD]]. Of the boys who had a ''[[tuli]]'' circumcision, 69 percent exhibited symptoms of PTSD.<ref>{{REFjournal
|last=Boyle
|first=Gregory J.
|init=GJ
|author-link=Gregory J. Boyle
|last2=Ramos
|first2=Samuel
|init2=S
|author2-link=
|etal=no
|title=Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: A retrospective cohort study
|trans-title=
|language=English
|journal=Annals of Medicine and Surgery
|location=
|date=2019
|volume=42
|issue=
|pages=19-22
|url=https://www.sciencedirect.com/science/article/pii/S2049080119300305
|archived=
|quote=
|pubmedID=31080593
|pubmedCID=6506608
|DOI=10.1016/j.amsu.2019.04.004
|accessdate=2020-11-28
}}</ref>
==Symptoms and signs of PTSD==
===Re-experiencing Symptoms===
Re-experiencing is the most typical symptom of PTSD & C-PTSD. This is when a person involuntarily and vividly relives the traumatic event.
* Flashbacks—reliving the traumatic event, and feeling like it happening right now including physical symptoms such as a racing heart or sweating.
* Reoccurring memories or nightmares related to the event.
* Distressing and intrusive thoughts or images.
* Physical sensations like sweating, trembling, pain or feeling sick.
Thoughts and feelings can trigger these symptoms, as well as words, objects, or situations that are reminders of the event.
===Alertness and Reactivity Symptoms===
You may be ‘jittery’, or always alert and on the lookout for danger. You might suddenly become angry or irritable.
* Being jumpy and easily startled.
* Feeling tense, on guard, or “on edge” – this is called hypervigilance.
* Having difficulty concentrating on even simple and everyday tasks.
* Having difficulty falling asleep or staying asleep.
* Feeling irritable and having angry or aggressive outbursts.
* Self-destructive or reckless behaviour.
* Aversion or difficulty in tolerating sound.
===Avoidance Symptoms===
Trying to avoid being reminded of the traumatic event is another key symptom of PTSD & C-PTSD: avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.
* Staying away from places, events, or objects that are reminders of the experience.
* Feeling that you need to keep yourself busy all the time.
* Using alcohol or drugs to avoid memories.
* Feeling emotionally numb or cut off from your feelings.
* Feeling numb or detached from your body.
* Being unable to remember details of the trauma.
Avoidance symptoms may cause people to change their routines.
===Feeling and mood symptoms===
The way you think about yourself and others may change because of the trauma.
* Trouble remembering key features of the traumatic event.
* Feeling like you can’t trust anyone.
* Distorted thoughts about the trauma that cause feelings of blame and guilt.
* Overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame.
* Loss of interest in previous activities.
* Feeling like nowhere is safe.
* Difficulty feeling positive emotions, such as happiness or satisfaction.<ref>{{REFweb
|url=https://www.ptsduk.org/what-is-ptsd/symptoms-of-ptsd/
|archived=
|title=PTSD-UK
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=
|website=https://www.ptsduk.org
|date=2021
|accessdate=2021-08-12
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|quote=When we feel stressed emotionally, our bodies release hormones called cortisol and adrenaline. This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze‘ response.
}}</ref>
{{SEEALSO}}
* [[Adverse Childhood Experiences (ACEs)]]* [[Circumstraint]]
* [[Pain]]
* [[Psychological issues of male circumcision]]
* [[Psychiatrist Discusses the Lasting Trauma of Circumcision]]
* [[Trauma]]
* [[Tuli]]
{{LINKS}}
* {{REFweb
|url=https://www.betterhealth.vic.gov.au/health/HealthyLiving/trauma-and-children-newborns-to-two-years
|archived=
|title=Trauma and children - newborns to two years
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=Victoria Department of Health
|website=Better Health Channel
|date=2020
|accessdate=2021-08-14
|format=
|quote=
}}
* {{REFweb
|url=https://www.friendshipcircle.org/blog/2013/07/12/post-traumatic-stress-disorder-in-babies-and-toddlers-what-are-the-symptoms/
|archived=
|title=Post Traumatic Stress Disorder in Babies and Toddlers: What Are the Symptoms?
|trans-title=
|language=
|last=Philo
|first=Jolene
|author-link=
|publisher=Special Needs Resources
|website=
|date=2013-07-12
|accessdate=2021-08-14
|format=
|quote=It’s normal for children to exhibit some of these behaviors in the first weeks after a significant trauma occurs. But if the behaviors persist more than 3 months after the initial event, treatment may be needed.
}}
{{REF}}
[[Category:Circumcision risk]]
[[Category:Pain]]
[[Category:Psychology]]
[[Category:Trauma]]
[[de:Posttraumatische Belastungsstörung]]