Doubt cast on definition of PTSD

New Scientist is reporting on a new study that questions the definition of post-traumatic stress disorder, based on the fact that a group of severely depressed patients seem to experience PTSD symptoms despite never having suffered a significant trauma.

PTSD is one of the only psychiatric disorders that includes a specific cause in its definition: a traumatic experience that involved likely death or injury to self or others, which was strong enough to cause fear, helplessness or horror.

If this experience results in intrusive memories of the event, persistent arousal and avoidance or dissociation, a person can be diagnosed with PTSD.

This new study, led by psychiatrist Prof Alexander Bodkin, found that almost 80% of a group of severely depressed patients experienced enough symptoms to be diagnosed with PTSD, despite never having been in a traumatic incident.

This suggests that the mental disorder thought to be specific to PTSD may, in fact, not be specific to trauma.

This is not the first time that the validity of PTSD has been questioned. Indeed, it has been a controversial diagnosis since it was first introduced.

As described by some excellent histories of military psychiatry, the acceptance of PTSD as a psychiatric diagnosis was in no small part due to pressure from Vietnam war veterans’ groups who wanted the military and state to provide treatment for the effects of traumatic combat stress.

Although PTSD is often described as the modern diagnosis of what used to be called ‘shell shock’, records from Word War I show ‘shell shock’ to be quite different in many respects, more closely resembling conversion disorder – a condition where emotional trauma can be expressed as physical symptoms such as paralysis and convulsions.

Before ‘shell shock’, combat stress was often diagnosed as ‘soldiers heart’. It’s interesting to note how the concept of combat stress has become more psychological and less physical as time has progressed.

However, most diagnoses of combat stress, in whatever form they have taken, have usually been strongly opposed by the military – who see it as taking soldiers away from the front line, and the government – who are reluctant to compensate soldiers for the inevitable consequences of life-threatening missions.

Many clinicians will, perhaps, not be concerned on a day-to-day basis if the symptoms of PTSD are found not to be specific to the disorder, as they can still treat the symptoms, regardless of how they are classified.

Nevertheless, the implications for research and health care provision (which often relies on confirming a specific diagnosis) could be more profound, particularly if the definition is changed or rejected as a result.

However, this is not likely to happen in the near future, although no one really knows what modifications to the definition of many mental disorders are due in the next edition of the DSM diagnostic manual.

Link to NewSci article ‘Doubt cast on definition of PTSD’.
Link to study abstract.
Link to excellent review of Shephard’s book War of Nerves.

2 Comments

  1. Posted March 22, 2007 at 7:15 pm | Permalink

    I think you are correct in suggesting that the diagnosis category of PTSD is not going to go away. We can only imagine the headlines: “Psychs tell returning soldiers PTSD not real.” That would cause all sorts of barriers for those who work with the returning troops.
    But all of us have seen PTSD overused. I know of a family who are all seen in a community mental health agency I used to work for. The family was evicted from their apartment for financial reasons but public housing was quickly found. But all three children were quickly diagnosed with PTSD because of the trauma of the experience.
    The problem with over diagnosis is that it harms the client by getting in the way of valid and effective treatment.
    Perhaps the solution is to make the definition much tighter. Find some way to confine it to soldiers, the people who respond to airline accidents and such, firefighters, etc. I suspect the best way to tighten it is to tighten the descrption of the traumatic event.

  2. chiron613
    Posted April 4, 2007 at 7:43 pm | Permalink

    Since a primary symptom of PTSD is intrusive memories of the traumatic incident, I cannot see how depressive people who have not had a trauma, can have symptoms of PTSD.


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