PTSD is the trendy diagnosis plagued with contentions and future growth problems. Does the industry continue to expand criterion so eventually everything but the kitchen sink can befit PTSD? Or decisions need to be made that curb the political influence and remove public pressures for political correctness upon organizations such as the World Health Organization and American Psychiatric Association in structuring mental health criterion?

To keep this article focused, we’ve excluded posting PTSD diagnostic version history. See: Third edition,  Fourth editionFifth edition.

Lets talk diagnostic problems

Criterion creep is nothing new when discussing diagnostic scope, it simply means that trauma experts try to include more avenues to meet diagnosis with each diagnostic progression. This is often done to conclude a valid outcome that contains speculative data. What does that mean?

Well… valid data is found, yet limited when compared to speculative data. The problem with criterion creep is that practicing therapists transition speculative opinion and data within their diagnostic procedures. They then push their view, their opinion, beliefs even, upon their clients, who then perpetuate such knowledge as though factual.

This is how we see newcomers to MyPTSD claim their therapist diagnosed them with PTSD for their spouse cheating on them. A cheating spouse does not meet criterion A, yet here they appear nonetheless. Worse, they appear stating their therapist diagnosed them with PTSD purely because their spouse cheated on them.

Professionals are a diagnostic problem.

I like to think that McNally hit the nail on the proverbial head and solved criterion creep adequately:

One unintended consequence of peace and prosperity is a liberalised definition of what counts as a traumatic stressor. The threshold for classifying an experience as traumatic is lower when times are good. In the absence of catastrophic stressors such as war, specialists in traumatic stress turn their attention elsewhere, discovering new sources of victims of hitherto unrecognised trauma.

The other side to this equation is that the very improvements in living standards and reduced violence we created make people sensitive to stressors that would not otherwise have affected previous generations. Maybe the better we make our lives, the more sensitive we become to what is traumatic?

Mental health diagnosis and application is what I would consider the largest problem. When you visit your doctor feeling unwell, physical tests more often than not will identify whether a physical issue exists. When you visit a therapist (psychiatrist downwards) you enter a world of philosophical diagnosis and theoretical hypothesis.

The industry is working with tools available at this time. Dr. Thomas Insel, former Director of the National Institute of Mental Health (NIMH) said it best at the 2015 Smithsonian “Future is Here” festival: “In 2015, I can’t tell you — nor can anyone else — how the brain functions as an information processing organ. How does it do it? What is meaning, how is it stored, where does it exist, what does it look like in the brain?”

Google “what we know about the brain and memory” and begin reading the different explanations of memory storage, encoding and retrieval from websites you would consider authoritative sources. You will immediately begin reading different theories. One should note such words, theories vs fact. Yet today’s theory, one could argue, is today’s fact.

See what I just did? Philosophical discussion. That is the basis of the mental health industry.

A former director of the NIMH, Steven E. Hyman, wondered whether the DSM diagnoses are more reifications, and not labels for genuine medical conditions. (Reifications are complex ideas when treating something immaterial — like happiness, fear, or evil — as a material thing. A wedding ring is the reification of a couple’s love.)

Symptom overlap is prevalent within the DSM and ICD categorical structure, comorbidity is now the rule, instead of exception. The same symptoms (written the same or similarly) appearing across multiple disorders, for example, half the symptoms in the DSM IV are directly or indirectly connected when viewed through a network approach.

To put this as simple as possible — if you inserted your cause and symptoms into an algorithm that searched current mental health diagnoses, you’re more likely, than not, to be returned multiple valid diagnostic options. So does this mean you have all these diagnoses? According to doctrine, you certainly could be diagnosed with them all.

A person may meet anxiety, depression, sleep and social disorders uniquely, yet if we went back to that algorithm, PTSD would likely exist within the output list because it contains many of the symptoms in these very diagnoses. This brings us around to criterion A and whether its importance should be adhered at all costs.

Post traumatic stress disorder has little valid evidence to support itself. This conclusion was made by a traumatologist group assigned to aid in correcting the issues with the PTSD diagnosis for the DSM V. The problem though, is they also had no valid solutions to the problems. Still philosophical.

There are vast differences between the DSM and ICD versions for PTSD diagnosis. Why? The ICD does not include numbing symptoms. The ICD 11 is proposed to tighten PTSD criterion to such extent that it will become difficult to diagnose. PTSD is entered as a rare, severe, diagnosis for those having experienced catastrophic trauma that no person should reasonably expect to endure within their lifetime.

One of the largest issues is attempting to define specific traumatic events. Back to that criterion A problem. Is PTSD simply chasing its tail trying to implement any limit on “what is traumatic enough” for a diagnosis?

Diagnostic solutions are equally problematic too. Part three…

The Future of PTSD Part 1The Future of PTSD Part 2The Future of PTSD Part 3

Bio’s

Written by Anthony, who founded MyPTSD in 2005. He is a veteran, writer, and web designer. He lives with his wife and two heinously cute puppies in Melbourne.

Edited by Simon, who earned her writing degree in 2011. She hopes to one day garner a doctorate in composition. You can find her on MyPTSD, where she talks (too much) about her dogs, life, the multiverse, and Everything.