Bret A. Moore Psy.D., ABPP

The Camouflage Couch

Post-Traumatic Stress Disorder

PTSD: Disorder or Injury?

Posttraumatic Stress Disorder or Posttraumatic Stress Injury

Posted Oct 12, 2014

A little known semantic battle that has garnered considerable attention of late is the issue of changing the term "Post-traumatic Stress Disorder" to "Post-traumatic Stress".  The opposing forces are both powerful and convincing in their own rights.  On one side are former president George W. Bush, retired Army Gen. Pete Chiarelli, and a number of veterans groups who believe the "D" should be dropped from PTSD. On the other side is the formidable psychiatric community which controls the Diagnostic and Statistical Manual of Mental Disorders--the publication that houses the diagnosis. 

Like most debates, there is clearly no absolute right or wrong answer.  Both courses of action contain their own merits and possess myriad risks. 

Those who support dropping the "D" believe that doing so will reduce the stigma associated with seeking help for PTSD, thereby increasing the number of troops who come forward.  Moreover, it's believed that equating the current disorder to an "injury" will change the perception of the American public leading to greater acceptance of the traumatized men and women who reintegrate back into their communities after combat. 

Those against the name change cite reasons that resonate primarily in academic and professional circles, but are nonetheless relevant and important.  Categorizing symptoms into a distinct and uniform disorder allows researchers to determine which treatments work, identify those most at risk for developing the disorder, and possibly develop methods for preventing it.  

As a psychologist who has ties to the academic and professional psychiatric circles and a veteran who sought help for posttraumatic stress, I see the merits of both sides of the debate. However, I believe that simply changing the name of the disorder will do little to increase access to care for troops or change the perceptions of the American people. 

There is little evidence supporting the notion that service members do not seek help for PTSD because of stigma.  In fact, the Veterans Administration is encountering record numbers of disability claims for PTSD when the prevalence of the disorder from Iraq and Afghanistan are equal to or less than previous conflicts.  And to my knowledge, there is no evidence indicating that a name change will cause more men and women to come forward. 

Although the intentions of the proponents for the name change are sincere and based in respect and caring for our service members and veterans, the unintended consequences could be dire. 

Comparing PTSD to a physical injury such as an ankle sprain could minimize the seriousness of the disorder.  If that happens, troops may be embarrassed to seek help considering they live in a culture that embraces a "suck it up and drive on" mentality.  And a shift in the general public's perception about PTSD along similar lines could lead to less acceptance and understanding as well as reduced funding to support research and treatment. Both would be an injury to the progress we've made over the past several decades in understanding PTSD.

For more information about PTSD and military trauma, check out Dr. Moore's book "Wheels Down: Adjusting to Life after Deployment."