Post-traumatic stress disorder (PTSD) was first officially described in 1980 in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, but its diagnostic criteria have been revised in nearly all subsequent updates to the Manual. Furthermore, the definitions and classification of related stress disorders present in the DSM-5 are partly discordant with those presented by the International Classification of Diseases (ICD) -11, which helps to increase rather than reduce confusion between these conditions. The difficulty in defining PTSD seems to be represented by its most distinctive aspect, namely the need for a traumatic event for the disorder to manifest itself: based on how trauma is understood, the difference between PTSD and other related stress disorders follows. This descriptive and comprehensive paper therefore aims to retrace the evolution of this disease, not only in its definition but also in relation to new neurobiological discoveries that have contributed, especially in recent years, to the evaluation of new therapeutic options, which will then be described, despite the pathophysiology of the disorder being largely unknown. The literature search was conducted using the following internationally recognized electronic databases: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, PsycINFO. By combining the English keywords with the MeSH (Medical Subject Headings) terms and establishing the inclusion and exclusion criteria a priori, the articles to be analyzed for the writing of the paper were selected. The original DSM texts were also consulted, with particular reference to the third, fourth and fifth editions, including their revisions, and the official guidelines of the Department of Veterans Affairs/Department of Defense (VA/DoD) of the United States, the National Institute for Health and Care Excellence (NICE) of the United Kingdom, the Italian Society of Psychiatry, the Istituto Superiore di Sanità and of the Trauma Guidelines Working Group of ISTSS (International Society for Traumatic Stress Studies).The critical review of the selected sources highlighted the lack of clarity in some aspects of the DSM-5 definition of PTSD, such as the type of exposure, the distinction between the term trauma and stress, or the concept of onset. Furthermore, there is insufficient literature available for studies conducted in developing countries demonstrating how the manifestation of the disorder can be influenced by different socio-cultural aspects or the validity of its diagnostic criteria, according to the DSM or ICD, both drawn up based on Western experience, even in other contexts. Similarly, it has been found difficult to find papers on clinical trials conducted with sufficient scientific and methodological rigor to evaluate the efficacy and safety of alternative therapeutic approaches, allowing them to be officially included in the indications for the treatment of PTSD. To confirm the new neurobiological discoveries, however, it is necessary to continue research, also investing in the development of the methods employed in this context. The definition of PTSD is therefore still in progress and is likely to be modified in the future, also in relation to what will be further discoveries on the psychopathology of the disorder. It is likely that this knowledge will also find application in defining the most effective type of treatment based on the specific clinical manifestation presented by the patient. If the psychopathology of PTSD is defined in more detail, it is desirable that a uniformity of classification between the DSM and the ICD is also found for the definition of related stress or trauma disorders, not understanding these two terms as synonyms unless the distinction has no clinical utility.
Il disturbo da stress post-traumatico (PTSD) è stato descritto per la prima volta ufficialmente nel 1980 nel Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, ma i suoi criteri diagnostici sono stati revisionati pressoché in tutti gli aggiornamenti successivi del Manuale. Non solo, le definizioni e la classificazione dei disturbi stress correlati presenti nel DSM-5 sono in parte discordanti rispetto a quelle presentate dall’International Classification of Diseases (ICD) -11, il che contribuisce ad aumentare anziché ridurre la confusione tra queste condizioni. La difficoltà di definizione del PTSD sembra essere rappresentata dal suo aspetto più distintivo, ovvero la necessità di un evento traumatico perché il disturbo si possa manifestare: sulla base di come si intende il trauma segue la differenza tra il PTSD ed altri disturbi stress correlati. Con il presente elaborato, di natura compilativa-descrittiva, si vuole quindi ripercorrere l’evoluzione di questa malattia, non solo nella sua definizione, ma anche in relazione alle nuove scoperte neurobiologiche che hanno contribuito, specialmente negli ultimi anni, alla valutazione di nuove opzioni terapeutiche, che verranno quindi descritte, nonostante la fisiopatologia del disturbo risulti per la maggior parte ancora sconosciuta. La ricerca bibliografica è stata condotta utilizzando le seguenti banche dati elettroniche riconosciute a livello internazionale: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, PsycINFO. Combinando le parole chiavi in inglese con i termini MeSH (Medical Subject Headings) e stabilendo a priori i criteri di inclusione ed esclusione, sono stati selezionati gli articoli da analizzare per la stesura dell’elaborato. Sono anche stati consultati i testi originali del DSM, con particolare riferimento alla terza, quarta e quinta edizione, comprese le loro revisioni, e le linee guida ufficiali del Department of Veterans Affairs/Department of Defense (VA/DoD) degli Stati Uniti, del National Institute for Health and Care Excellence (NICE) del Regno Unito, della Società Italiana di Psichiatria, dell’Istituto Superiore di Sanità e del Trauma Guidelines Working Group dell'ISTSS (International Society for Traumatic Stress Studies). La revisione critica delle fonti selezionate ha evidenziato la mancanza di chiarezza di alcuni aspetti della definizione di PTSD del DSM-5, quali per esempio la tipologia di esposizione, la distinzione tra il termine trauma e stress o il concetto di onset. Inoltre non c’è in letteratura sufficiente disponibilità per studi condotti nei Paesi in via di sviluppo che dimostrino come la manifestazione del disturbo possa essere influenzata da aspetti socio-culturali diversi o la validità dei suoi criteri diagnostici, secondo il DSM o l’ICD, entrambi redatti basandosi sull’esperienza Occidentale, anche in altre realtà. Allo stesso modo è stata riscontrata la difficoltà nel reperire sperimentazioni condotte con sufficiente rigore scientifico metodologico per valutare l’efficacia e la sicurezza di approcci terapeutici alternativi, tale da permetterne l’inserimento ufficialmente nelle indicazioni per il trattamento del PTSD. Per confermare le nuove scoperte neurobiologiche è invece necessario portarne avanti la ricerca investendo anche nello sviluppo delle metodiche impiegabili in questo campo. La definizione del PTSD risulta quindi ancora in divenire ed è probabile che venga modificata in futuro, anche in relazione a quelle che saranno le ulteriori scoperte sulla psicopatologia del disturbo. È verosimile che queste conoscenze trovino poi applicazione anche nel determinare il tipo di trattamento più efficace sulla base della manifestazione clinica specifica presentata dal paziente. Se si verrà a definire più dettagliatamente la psicopatologia del PTSD è auspicabile che si ritrovi anche un’uniformità di classificazione tra il DSM e l’ICD per i disturbi st
L'evoluzione del disturbo post- traumatico da stress: una revisione sistematica della letteratura
BERUTTO, CECILIA
2025/2026
Abstract
Post-traumatic stress disorder (PTSD) was first officially described in 1980 in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, but its diagnostic criteria have been revised in nearly all subsequent updates to the Manual. Furthermore, the definitions and classification of related stress disorders present in the DSM-5 are partly discordant with those presented by the International Classification of Diseases (ICD) -11, which helps to increase rather than reduce confusion between these conditions. The difficulty in defining PTSD seems to be represented by its most distinctive aspect, namely the need for a traumatic event for the disorder to manifest itself: based on how trauma is understood, the difference between PTSD and other related stress disorders follows. This descriptive and comprehensive paper therefore aims to retrace the evolution of this disease, not only in its definition but also in relation to new neurobiological discoveries that have contributed, especially in recent years, to the evaluation of new therapeutic options, which will then be described, despite the pathophysiology of the disorder being largely unknown. The literature search was conducted using the following internationally recognized electronic databases: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, PsycINFO. By combining the English keywords with the MeSH (Medical Subject Headings) terms and establishing the inclusion and exclusion criteria a priori, the articles to be analyzed for the writing of the paper were selected. The original DSM texts were also consulted, with particular reference to the third, fourth and fifth editions, including their revisions, and the official guidelines of the Department of Veterans Affairs/Department of Defense (VA/DoD) of the United States, the National Institute for Health and Care Excellence (NICE) of the United Kingdom, the Italian Society of Psychiatry, the Istituto Superiore di Sanità and of the Trauma Guidelines Working Group of ISTSS (International Society for Traumatic Stress Studies).The critical review of the selected sources highlighted the lack of clarity in some aspects of the DSM-5 definition of PTSD, such as the type of exposure, the distinction between the term trauma and stress, or the concept of onset. Furthermore, there is insufficient literature available for studies conducted in developing countries demonstrating how the manifestation of the disorder can be influenced by different socio-cultural aspects or the validity of its diagnostic criteria, according to the DSM or ICD, both drawn up based on Western experience, even in other contexts. Similarly, it has been found difficult to find papers on clinical trials conducted with sufficient scientific and methodological rigor to evaluate the efficacy and safety of alternative therapeutic approaches, allowing them to be officially included in the indications for the treatment of PTSD. To confirm the new neurobiological discoveries, however, it is necessary to continue research, also investing in the development of the methods employed in this context. The definition of PTSD is therefore still in progress and is likely to be modified in the future, also in relation to what will be further discoveries on the psychopathology of the disorder. It is likely that this knowledge will also find application in defining the most effective type of treatment based on the specific clinical manifestation presented by the patient. If the psychopathology of PTSD is defined in more detail, it is desirable that a uniformity of classification between the DSM and the ICD is also found for the definition of related stress or trauma disorders, not understanding these two terms as synonyms unless the distinction has no clinical utility.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/108930