Scientific American has a knock-out article that questions whether the diagnosis of post-traumatic stress disorder is a coherent psychological concept or whether it is actually making the situation worse for soldiers with post-combat mental health problems.
As we’ve noted before, PTSD is a controversial diagnosis for two major reasons. The first is that it is not clear that the diagnosis describes anything different from other forms of anxiety and depression, except for that fact that it is related to a specific traumatic incident.
The second is that the diagnosis was largely introduced after pressure from veterans’ lobbying groups after the Vietnam war. In fact, PTSD was originally called ‘post-Vietnam syndrome’ and there are concerns that while it was politically expedient at the time, the concept doesn’t lead to good mental health care.
In fact, combat stress reactions have taken various forms through the years of which PTSD is the latest reincarnation.
The SciAm article tackles research in the US military suggesting that the syndrome is over-diagnosed and that the treatment plan is counter-productive and actually encourages people to remain disabled.
But one of the most interesting things about the article is that it tackles the one of the core features of the diagnosis – that the anxiety symptoms are directly tied to a specific traumatic event.
Many people who are diagnosed with PTSD turn out not to have been traumatised by the event they later attribute the trauma to, or may not have even been traumatised at all.
J. Alexander Bodkin, a psychiatrist at Harvard’s McLean Hospital, screened 90 clinically depressed patients separately for PTSD symptoms and for trauma, then compared the results. First he and a colleague used a standardized screening interview to assess symptoms. Then two other PTSD diagnosticians, ignorant of the symptom reports, used another standard interview to see which patients had ever experienced trauma fitting DSM-IV criteria.
If PTSD arose from trauma, the patients with PTSD symptoms should have histories of trauma, and those with trauma should show more PTSD. It was not so. Although the symptom screens rated 70 of the 90 patients positive for PTSD, the trauma screens found only 54 who had suffered trauma: the diagnosed PTSD “cases” outnumbered those who had experienced traumatic events. Things got worse when Bodkin compared the diagnoses one on one. If PTSD required trauma, then the 54 trauma-exposed patients should account for most of the 70 PTSD-positive patients. But the PTSD-symptomatic patients were equally distributed among the trauma-positive and the trauma-negative groups. The PTSD rate had zero relation to the trauma rate. It was, Bodkin observed, “a scientifically unacceptable situation.”
This does not necessarily mean the people are lying, but may simply be attributing true symptoms to an unlikely source.
It’s a wonderfully thought-provoking article that’s sure to ruffle a few feathers.
The writer, David Dobbs, has also put a load of background material and links to the relevant studies on his blog, so you can get a more in-depth perspective if it sparks your interest in the area.