PTSD Without Trauma? A Scientific American article examines some controversies about diagnostic criteria for PTSD
When I was delving into the trauma literature for my dissertation several years ago, I noticed a study that—while not particularly relevant to my needs at the time – offered an intriguing finding. Bodkin, Pope, Detke, and Hudson (2007) found equivalent rates of PTSD symptoms between individuals who did (78%) and did not (78%) report a history of trauma. That is, a significant portion of their sample (who had major depression) similarly exhibited symptoms for PTSD, regardless of whether they had had been exposed to a trauma or not.
This was the first time I became aware of an ongoing controversy relating to how PTSD is diagnosed. In our current nosology (as defined in the DSM-IV), a PTSD diagnosis requires a person to have experienced a traumatic event–Criterion A, defined as threat of injury or death to self or others. However, some data seem to indicate that people can can experience PTSD-like symptoms even in the absence of an identifiable Criterion A trauma (as defined by the DSM-IV). There is a large group of proponents who think this reveals a deep flaw in our diagnostic critera for PTSD.
For a brief summary of this controversy, check out, Rosen, Spitzer, & McHugh (2008; click on this link for the full pdf). As I’ve written about in a previous post, the current task force is considering tightening up the criterion A definition of what is considered a traumatic event.
I bring all this up now because the controversy has reached the popular press. In an April issue of Scientific American (reprinted online in May), Scott Lilienfeld and Hal Arkowitz provide a brief, readable summary of these concerns in their article, “Does Post-Traumatic Stress Disorder Require Trauma?”
This is an issue that can be easily misinterpreted by the public. Critics of diagnostic criteria of DSM are not suggesting that PTSD does not exist; rather, the concern is that our understanding of PTSD and the criteria we use to diagnose it are seriously flawed.
I look forward to watching how this debate plays out in the revision process for the DSM-V.