Toward Validation of the Diagnosis of Posttraumatic Stress Disorder

Abstract

Unlike most psychiatric diagnoses, posttraumatic stress disorder (PTSD) is defined in relation to a potentially etiologic event (the traumatic "stressor criterion") that is fundamental to its conceptualization. The diagnosis of PTSD thus inherently depends on two separate but confounded processes: exposure to trauma and development of a specific pattern of symptoms that appear following the trauma. Attempts to define the range of trauma exposure inherent in the diagnosis of PTSD have generated controversy, as reflected in successive revisions of the criterion from DSM-III onward. It is still not established whether or not there are specific types of traumatic events and levels of exposure to them that are associated with a syndrome that is cohesive in clinical characteristics, biological correlates, familial patterns, and longitudinal diagnostic stability. On the other hand, the symptomatic description of PTSD is becoming more clear. Of three categories of symptoms associated with PTSD--intrusive memories, avoidance and numbing, and hyperarousal--avoidance and numbing appear to be the most specific for identification of PTSD. Research is now poised to answer questions about the relevance of traumatic events based on their relationship to symptomatic outcome. The authors recommend that future research begin with existing diagnostic criteria, testing and further refining them in accordance with the classic Robins and Guze strategy for validation of psychiatric diagnoses. In this process, diligent adherence to the criteria under examination is paramount to successful PTSD research, and changes in criteria are driven by empirical data rather than theory. Collaborations among trauma research biologists, epidemiologists, and nosologists to map the correspondence between the clinical and biological indicators of psychopathology are necessary to advance validation and further understanding of PTSD.

Can a Posttraumatic Stress Disorder be caused by a Traumatic Injury to a Companion Pet?

“…Kilpatrick et al [11] argued the importance of reconsidering Criteria A to ensure an accurate and comprehensive diagnosis. Specifically, they recommend that Criteria A be retained; however, with a statement indicating the "list of events is not exhaustive" and other stressors not stated may also lead to PTSD Kilpatrick et al [11], North et al [12]. This addition would provide the flexibility to capture people who have symptoms to warrant services yet do not meet the DSM-IV-TR's Criteria A (American Psychiatric Association, 2000) [1].…”

Can a Posttraumatic Stress Disorder Be Caused by a Traumatic Injury to a Companion Pet?

“…Specifically, they recommend that Criteria A be retained; however, with a statement indicating the "list of events is not exhaustive" and other stressors not stated may also lead to PTSD (Kilpatrick, Resnick, &Acierno, 2009, p. 381;North, Suris, Davis, & Smith, 2009). This addition would provide the flexibility to capture people who have symptoms to warrant services yet do not meet the DSM-IV-TR's Criteria A (American Psychiatric Association, 2000).…”

Traumatic injury and identity: Incorporating traumatic episodes into the life story

“…Since this time, there has been much controversy over this diagnosis; arguments have included what symptoms should constitute the disorder and whether the diagnosis is even valid (North, 2009). DSM-IV-TR criteria for PTSD include: 1) exposure to a life-threatening event (can include direct exposure or witnessing or learning about the event of a close other) and can also include the threat of serious injury or threat to bodily integrity; 2) response of intense fear, helplessness, or horror following the event; 3) re-experiencing the traumatic event (e.g., intrusive, distressing thoughts; recurrent, distressing dreams, flashbacks); 4) avoidance of such things related to the traumatic event (e.g., thoughts, feelings related to the event;…”

“…At this point, what is lacking in the literature is an investigation of the biology behind the diagnosis, differential diagnoses, and familial patterns (North, 2009). One central argument regarding the PTSD diagnosis surrounds whether the requirement of experiencing (or witnessing or learning about) a traumatic event should exist within the diagnostic criteria.…”

“…One central argument regarding the PTSD diagnosis surrounds whether the requirement of experiencing (or witnessing or learning about) a traumatic event should exist within the diagnostic criteria. Some argue that there are consequences to assigning causality -specifically, that doing so prevents researchers from investigating other possible causes of PTSD (North, 2009). …”