Nosology of PTSD

Posted to Traumatic-Stress Forum on 12 July, 1996.

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In my work with veterans, primarily Vietnam War veterans, perhaps the most difficult area I face is in diagnosing what is going on with these patients. Specifically, whether they have PTSD or not.

Our team here at the VA in Des Moines, Iowa, has struggled with this for over three years, and are beginning to come up with some approaches which we think make sense. Further, the way we are coming to look at the diagnosis of PTSD can help to make some sense of a field which is becoming increasingly fragmented, contentious, and confused.

The particular difficulty which we face with our population is that the traumatic events with which we are dealing occurred over 20 years ago. In addition, the question of compensation muddies the waters significantly.

In wrestling with this diagnostic dilemma, we have found ourselves at times making a diagnosis without sufficient evidence; conversely, we have at times determined that a PTSD diagnosis was not supported by credible evidence. Which means that we were, in fact, making judgments as to both credibility of the informant, and severity of the purported stressor.

The upshot has been a significant degree of discomfort with our diagnoses.

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intuitions; it is also consistent with our experience with veterans. Most of those who were in Vietnam and experienced traumatic events got over their symptoms. It is also consistent with our experience with former POW's from WWII. To put it bluntly: People normally get over PTSD. It is not a chronic illness or condition, just as Bereavement is not a chronic condition. If the symptoms of PTSD persist, then we have something more than simple PTSD. I propose we call this Complicated PTSD. (This is not to be confused with the proposed category of Complex PTSD.) PTSD itself, then, is, on my view, self-limiting. I would suggest that we not consider it an illness or a disorder, any more than we consider Bereavement an illness or disorder. This does not mean that those responding to traumatic events may not benefit from assistance; clearly, they may. Just as those undergoing Bereavement may very well benefit from support, assistance, even therapy (including medication). In addition to viewing PTSD as self-limiting, I also propose that we recognize that the sine qua non of the diagnosis is a traumatic stressor . There is a strain within the traumatology community which seems intent on eliminating, or at least minimizing, the importanc
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Some common words found in the essay are:
PTSD PTSD, Moines Iowa, PTSD Bereavement, Complicated Bereavement, Emotions Conduct, Adjustment Disorder, Personality Disorder, Brain Disorders, POW's WWII, Stress Disorder, call forth, diagnosis ptsd, traumatic events, adjustment disorder, self-limiting process, symptoms persist, call forth syndrome, mixed disturbance, disturbance emotions, emotions conduct, symptoms ptsd, disturbance emotions conduct, events call forth, mixed disturbance emotions,
Approximate Word count = 1524
Approximate Pages = 6 (250 words per page)

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