Reconceptualizing combat-related posttraumatic stress disorder as an occupational hazard

Abstract: Combat is clearly an occupational hazard with direct implications for mental health. In the case of the military, the mission dictates how often a service member leaves the base camp and is exposed to the combat conditions that can result in PTSD. Those in other occupations, such as firefighters and police officers, face risky environments as well. This issue of occupational risk associated with PTSD has gone largely unrecognized as it relates to the diagnostic conceptualization of the disorder. Unfortunately, the current diagnostic criteria for PTSD do not adopt an occupational health model. Instead, the criteria are based on a victim-based medical model. This decision to combine occupational risk with victimhood has obscured the critical differences between the two and has limited the examination of their unique diagnostic and prognostic pathways. The purpose of this chapter is to propose a reconceptualization of combat-related PTSD. This reconceptualization reviews the role of the definition of trauma, the context of symptoms, and the understanding of functional impairment.