Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: Psychiatric and Neurologic Aspects of War Posttraumatic stress disorder and traumatic stress: from bench to bedside, from war to disaster Robert J. Ursano, Matthew Goldenberg, Lei Zhang, Janis Carlton, Carol S. Fullerton, He Li, Luke Johnson, and David Benedek Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland Address for correspondence: Robert J. Ursano, M.D., Center for the Study of Traumatic Stress and Chairman, Department of Psychiatry, Uniformed Services University School of Medicine, 4301 Jones Bridge Rd, Bethesda, Maryland 20814. rursano@usuhs.mil War is a tragic event and its mental health consequences can be profound. Recent studies indicate substantial rates of posttraumatic stress disorder and other behavioral alterations because of war exposure. Understanding the psychological, behavioral, and neurobiological mechanism of mental health and behavioral changes related to war exposure is critical to helping those in need of care. Substantial work to encourage bench to bedside to community knowledge and communication is a core component of addressing this world health need. Keywords: posttraumatic stress disorder; disaster; treatment; neurobiology The ongoing war in Iraq and Afghanistan has led to high rates of posttraumatic stress, posttraumatic stress disorder (PTSD), depression, suicide, comor- bid concussions, traumatic brain injuries (TBIs), and other combat-related mental and behavioral health needs. Stigma associated with these prob- lems and other barriers to care heighten the com- plexity of addressing these mental and behavioral health needs. War inflicts a serious toll on soci- ety, particularly among the soldiers who must fight and their families. The physical effects of war— battle injuries and fatalities—have long been known and counted, but the psychological and behav- ioral effects of conflict—always known and often scorned—have only, more recently, been the focus of societal medical attention. The behavioral and psychological outcomes of exposure to traumatic events are complex and mul- tifactorial. The effects range from presumed epi- genetic alterations to the impact of exposure to life threat and altered interpersonal and social sup- port systems. In addition, a significant body of re- search indicates that the psychological effects of re- peated traumatic event exposure are cumulative. 1,2 However, repeated exposure to traumatic events has rarely been studied. In addition, while there are mul- tiple animal models of stress-associated illnesses, such as PTSD, depression, and substance abuse, these models replicate components of the human disorders but do not represent total models of the disease. While the majority of soldiers and veterans ex- hibit significant resilience in the face of trauma and growth as a result of their military service, many de- velop significant psychological and behavioral prob- lems related to their war experience. These problems include mental disorders, such as PTSD, depres- sion and substance abuse, as well as risk behaviors, and increased rates of suicide. War veterans also show increased risk of physical health problems and early death. Understanding how and why such prob- lems occur can help to identify those service mem- bers at highest risk and lead to the development of interventions to prevent and mitigate adverse outcomes. Disorders, illness, and distress In the last few decades we have gained a great deal of knowledge about the effects of war, although the observation of war syndromes span hundreds of doi: 10.1111/j.1749-6632.2010.05721.x 72 Ann. N.Y. Acad. Sci. 1208 (2010) 72–81 c  2010 Association for Research in Nervous and Mental Disease.