Last week I was interviewed by Alice Karekezi for Salon.Com. She asked me if I thought PTSD was over diagnosed.
There are actually two questions rolled up into this I think. The first is whether people are being inappropriately diagnosed with PTSD as defined by DSM. The second is whether the concept of PTSD has been over applied.
So, the first question; I think the vast majority of psychologists and psychiatrists are responsible professional people and are using the diagnostic category as it is meant to be used. Overall they are doing what it says on the tin.
It's what it says on the tin I wonder about. To the second question I wonder whether the concept of PTSD has been applied too widely.
It is my view that posttraumatic stress occurs in people following all sorts of threatening events and that these reactions are on a spectrum ranging from mild to severe levels. The job of psychiatric classification is to draw a line somewhere on that spectrum. Above the line, the person is suffering from a disorder, below the line they are not. I'm not saying that this is how it should be, simply that this is what is happening when a diagnosis is made. In my view the line has been drawn in such a way that a clear cut distinction is not made between those who are suffering from PTS and those who are suffering from PTSD.
To me it seems that to suffer from intrusive thoughts, upsetting memories and nightmares accompanied by attempts at avoidance, emotional numbing and problems sleeping, concentrating, and feelings of being on edge and tense, and so on following traumatic events is a normal and natural process - of personal transformation as the person works through the significance of what has happened to them and what it means. As distressing as such an experience may be it is not an illness. As such the term PTS seems appropriate.
The problem is if people who are suffering from PTS are given the diagnosis of PTSD. This happens because the diagnositic criteria do not make a distinction between PTS and PTSD.
So, when does the label PTSD become appropriate? In my view the label PTSD should be applied when it is clear that there is a dysfunction of these normal and natural mental mechanisms such that the person is unable to cognitively-emotionally process their experiences. We know that there are brain correlates but that line of research needs to go further and show that PTSD is a disorder of the brain.
In the context of psychiatric classification I simply think we ought to be cautious with the word disorder and to make sure that it means more than being distressed, different or difficult.
To find out more about my work: http://www.profstephenjoseph.com
To read the full interview with Alice Karekezi, see: http://www.salon.com/2011/11/15/how_ptsd_took_over_america/singleton/