The September 20 issue reports on a study in the June Archives of General Psychiatry indicating that about one-third of the jailed women in the study met the criteria for PTSD. Commenting on the study, Cassandra Newkirk, M.D., says, "PTSD has been greatly overlooked in incarcerated women. There has been a total insensitivity to a history of trauma." There were also high rates of major depression and substance abuse.

I do not think such findings are unique to an incarcerated population. In practice over the years I also found PTSD to be far more common than generally suspected. This should not be surprising, since everyone suffers trauma in life. Moreover, I found that individuals suffering from PTSD almost always avoid mention of the trauma; when questioned directly, they often deny trauma or symptoms. This is true, for example, for women who have been raped or experienced abuse in childhood. Reluctance to reveal the problem appears to be characteristic of PTSD; therefore, when a symptom unique to PTSD is found, additional symptoms must be sensitively explored.

Depression and substance abuse are common symptoms of PTSD. For example, I saw many patients who had been hospitalized repeatedly for major depression. They responded well when their PTSD was recognized and treated. I had similar experience with substance abusers who were often in detox programs. There again, detection of symptoms enabled treatment of the underlying PTSD.

I feel strongly that the average practitioner will benefit from an increased awareness of PTSD and the fact that it may underlie presenting symptoms including depression, substance abuse, and other disorders.

Merrill I. Lipton, M.D.

Belton, Tex.

(Psychiatric News, November 1, 1996)