Is High-Functioning PTSD Real?

Let me start by being very clear about two things:

First, the term “high-functioning PTSD” is not an official diagnostic term. You will not find it in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, the diagnostic bible used by American mental health professionals.

The DSM-5-TR is an important way of standardizing the definition of mental health conditions so that, as a field, we can move with some uniformity toward improving the diagnosis, treatment, and research of psychological conditions.

Though not without controversy the DSM does do one thing, it helps to stop overmedicalizing or over-pathologizing the human condition. Because there is no current blood test, urine test, ultrasound, or sophisticated imaging technique that can definitively diagnose PTSD these definitions matter.

In the DSM-5-TR you will find information about the diagnostic criteria for PTSD and information on two specifications or subtypes namely “dissociative” and “delayed” PTSD but nothing about “high-functioning PTSD.”

Second, a search of PubMed, a scientific literature database that helps users search and retrieve from the biomedical and life sciences literature, for the term high-functioning PTSD reveals very little indicating that it is not a term routinely being used by researchers or scientists working on the cutting edge of trauma science.

That said, the internet is full of content on “High-Functioning PTSD.” Indeed, a Google search serves up this definition which seems to be an aggregate of content featured on various websites run by mental health clinicians, clinics, and organizations.

“High-functioning PTSD is a term used to describe people who experience post-traumatic stress disorder (PTSD) symptoms while still appearing to function well in their daily lives. It's not an official diagnostic term, but it's important to recognize that people with high-functioning PTSD can face unique challenges and may go unnoticed”.

At first glance, the scientist in me is irked by the search engine output because this wording, “function well in their daily lives” seems to run counter to how we diagnose PTSD. PTSD, by definition, has a required Criterion G which states “Symptoms create distress or functional impairment (social, occupational.)”

But the clinician in me is so much more sympathetic. Often what clinicians see on the frontline, in their practice, signals a condition that the research world and “official” professional verbiage have yet to catch up. Because the clinician is duty-bound to alleviate suffering, they can’t ignore what they are seeing in their “real world” practice just because it does not fit neatly into a rigid research-based definition. Rather, they have to innovate and be creative and embrace all the messier parts and unknowns of what is unfolding in front of them.

Is high-functioning PTSD real? Answer: Probably (but not officially)