Posttraumatic stress disorder: future directions in science and practice.

Terence M. Keane, PhD For nearly 30 years, the U.S. Department of Veterans Affairs (VA) has led the scientific study of the effects of war on combatants. Beginning with the development of the diagnosis of posttraumatic stress disorder (PTSD) in the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders-Third Edition) and World Health Organization (International Classification of Diseases) classification schemes, the VA has supported growth in the world’s understanding of war, trauma, and PTSD. The growth in knowledge spans multiple levels of scientific analysis, from studies of behavioral genetics to pathophysiology, prevalence studies, treatment efficacy trials, and even effectiveness trials. In its most recent form, this progress is represented in the VA’s national dissemination of evidence-based treatments for those war veterans who are grappling with PTSD and related psychological disorders. For those of us who have worked in the veterans’ healthcare system for these past 30 years, the changes in scientific evidence, available clinical programming, and supportive public policy are great and deeply impressive. The present sequence of articles in the Journal of Rehabilitation Research and Development reflects the growth and maturation of the field. Yet more knowledge on the treatment of PTSD in combat soldiers and veterans is needed urgently as we enter the sixth year of conflict in the global war on terrorism.