Medical Definition Of Shell Shock: History, Modern Meaning, and Diagnosis

"Shell shock" or "feeling shell-shocked" are common phrases most of us have heard. But what does “shell shock” mean? Let's look at the true meaning of shell shock and the history of this term.

What is the definition of shell shock?

The term “shell shock” was coined during World War I (WWI) to describe psychological impairment following warfare. Shell shock was common among soldiers who experienced prolonged fighting or bombardment.

More recently, shell shock defines how one feels after experiencing a severe and unpleasant surprise. For example, you might hear someone say, "I felt shell-shocked," when reflecting upon an unexpected scary, or undesirable event.

However, this reference to shell shock is not entirely accurate because the term has since been replaced with the more accurate description of post-traumatic stress disorder¹ (PTSD). Additionally, shell shock was initially used in the context of war and was never intended to refer to circumstances outside of warfare.

The history of shell shock

Shell shock² was an attempt to label PTSD during WWI. Later in World War II (WWII), it was labeled "combat neurosis" (or "battle fatigue") instead. It wasn't until several years after the Vietnam War that shell shock and combat neurosis became known as PTSD.

Initially, shell shock was related to symptoms or conditions such as:

• Concussion

• Confusional states

• Exhaustion

• Neurasthenia (fatigue, irritability, and headache pain)

• Malingering (faking illness to escape duty)

• Hysterical neurosis (a condition characterized by emotional outbreaks or disturbances and a loss of sensory and motor function)

• Amnesia

• Difficulty sleeping

• Depression

• Despondency

• Nightmares

Unfortunately, during WWI and WW2, very little was known about the effects that warfare could have on mental illness. As a result, shell shock became an umbrella term for various psychological and neurological conditions experienced by soldiers who had been in combat.

Today we have a very different outlook on PTSD, and more refined criteria help people with PTSD get the right help. For example, experts now recognize that PTSD can potentially affect anyone who has experienced or witnessed a traumatic event.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that some people develop after a traumatic event. Such events are unpleasant, frightening, harmful, or dangerous and can have a lasting impact on the mind.

Anxiety from traumatic experiences is challenging to overcome, and many people struggle to cope. However, when this state persists for some time, it has the potential to become PTSD.

Seeking treatment or medical help for PTSD is vital because this condition can worsen without it. PTSD can significantly disrupt a person's life and cause strain on relationships.

Due to PTSD’s association with previous terms such as shell shock, certain misconceptions prevented people from asking for help. However, there is more awareness of the condition today, so getting a proper diagnosis and specialized help for PTSD has never been easier.

What causes PTSD?

PTSD is caused by seeing or experiencing a traumatic event not limited to combat or war.

Other examples include:

• Injuries

• Accidents

• Disasters

• Violence

• Abuse

• Terrorism

• Death

• Loss of loved ones, including heartbreak

PTSD is typically diagnosed sometime after a traumatic event has occurred. Therefore, it can take several months or years to be diagnosed.

However, not everyone who experiences a traumatic incident will develop PTSD. Sometimes, people can work through their anxiety before it progresses or develops into PTSD.

What symptoms are recognized for PTSD today?

Although PTSD now replaces the term "shell shock, the symptoms of the two conditions can vary. The symptoms listed for PTSD today are the ones that are generally accepted.

PTSD symptoms include:

• Flashbacks (moments when it feels like you are reliving the event)

• Worrying and negative thoughts about yourself and the world

• Avoiding reminders of the traumatic incident

• Feeling tense, on edge, or hyper-alert

• Sleep problems such as nightmares or difficulty falling or staying asleep

• Mood changes

• Feeling guilty

• Blaming yourself for the event

• Feeling disinterested in activities or hobbies that you previously enjoyed

If you’re experiencing these symptoms or have trouble managing them, it's best to see a doctor for further advice.

How common is PTSD?

Current statistics from the American Psychiatric Foundation³ show that 3.5% of American adults suffer from PTSD every year. One person in 11 is diagnosed with PTSD during their life.

However, regarding PTSD and war, one study⁴ of 60,000 veterans showed that 13.5% had PTSD. Other studies claim that the rate could be much higher, between 20% and 30%.

In comparison, during December 1914, 7%-10% of officers and 3%-4% of the enlisted ranks in the British Expeditionary Force were estimated to have experienced symptoms similar to shell shock.

This highlights today’s increased awareness of PTSD and that it’s easier to diagnose.

How is PTSD diagnosed?

No tests are required for a diagnosis of PTSD. Your doctor may ask questions about your symptoms to see whether you fit the criteria for PTSD.

If your doctor does order blood tests, this will often be to rule out any medical conditions, such as an underactive thyroid, that could be contributing to your PTSD symptoms.

When to see a doctor

If you’re feeling anxious and are struggling to cope, it's always best to see your doctor. A doctor can diagnose your condition and offer a range of treatment options for you to try.

If you have already been diagnosed with PTSD but feel your symptoms aren’t well managed, it is best to see a doctor. Regular appointments with your doctor can help you stay on top of this condition.

The lowdown

The term "shell shock" originated from WWI and was used to describe a range of psychological and neurological disorders that resulted from combat. However, this term has since been replaced, and its scope expanded with the current term, PTSD, and there are refined criteria for diagnosing this disorder.