Post Traumatic Stress Disorder: The Controversy

ptsdPost Traumatic stress disorder has stirred up a rather frothy debate over the last few years, especially around the definition of the traumatic event that precipitates the symptoms. It is by no means controversial that extremely traumatic events (combat veterans experiencing the perils of war, physical abuse, sexual abuse, natural disasters) should qualify as criterion, but what about purely psychosocial events without some type of physical injury? In DSM IV, an individual is not required to have directly experienced the trauma. In fact, the individual can merely witness it or just hear about it.

Of concern, has been a persistent expansion of what I refer to as “criteria creep.” Namely, an expansion of what constitutes a sufficiently serious enough trauma to categorize an individual’s symptoms as PTSD, as opposed to understandable feelings (anger, anxiety, agitation, irritability, frustration, etc.)  Examples include: watching a movie or a television show that is distressing, witnessing a real-time violent event, or hearing condescending comments about oneself.   

So does PTSD even exist? In a study conducted by researchers at McLean psychiatric hospital in Belmont, Massachusetts and reported on in the J. Anxiety Disord. 2007; 21: 176-82, one hundred and three subjects were asked if they had ever experienced a traumatic event. Even if they answered no, they were asked about symptoms of PTSD. Of those that had a traumatic experience, 78 percent also met symptomatic criteria for PTSD. Of those, who had never had a traumatic experience, 78 percent met symptomatic criteria for PTSD!

What does this mean? PTSD is not necessarily a post traumatic disorder, but instead a non-specific constellation of symptoms that often occur with or without trauma. It may therefore be inaccurate to assume that the symptoms are caused by trauma.

PTSD earned DSM diagnostic criteria after an analysis of the thoughts, feelings and behaviors of soldiers associated with the Vietnam War. Interestingly, reports indicated that approximately 33 percent of Vietnam veterans suffered PTSD at some point. Only 20 percent had ever seen combat.

Suggestions are being made that DSM V tighten up criteria such that only those that directly experience trauma can be assigned a diagnosis of PTSD; doing so will aid in demystifying what constitutes a sufficient trauma, and even more importantly, what doesn’t.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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