Undiagnosed PTSD

[Celexa]

Groundhog day in my consult clinic:

Pt has a history of either "depressionanxiety" or "bipolar".

I perform my evaluation.

Pt has textbook PTSD.

I discuss my findings with patient. Patient says something like "I've always suspected that but no one had ever [diagnosed me/confirmed that/talked to me about it]"

These are often satisfying visits because I can make a real difference (by getting them towards the right types of therapy and the right meds--including reducing antipsychotic use for the bipolar or psychotic disorder they do not have) but also, fill me with confusion that in the 10, 15, 20, 40 years since the index trauma(s) I'm the first person making the diagnosis. I was fortunate to receive very good trauma training including working with some excellent trauma specialist therapists. Is there a general reluctance or education gap that makes people hesitant to diagnosis PTSD? I'm genuinely baffled.

Now excuse me, I am off to perform a chart exorcism to try and banish another inaccurate bipolar diagnosis for a patient with an extensive childhood trauma history.

---

Members don't see this ad.

 

[WisNeuro]

Probably just incompetent evaluators thus far. If anything, PTSD is probably overdiagnosed at this specific moment in time as it's somewhat chic, and everything under the sun is a "traumatic event."

 

[tr]

I bet it's just from previous evaluators phoning it in on the social history evaluation. If you don't elicit the index event, from a cross-sectional perspective PTSD could look like almost any other psych diagnosis.

Also, globally poor interpersonal functioning as a result of violent/chaotic childhood doesn't have its own specifier. It's lumped in with adult-onset PTSD even though the observable manifestations can be very different.

I work with residents often and my observation is that if unprompted, very few of them will ask about childhood adversity on the intake visit. A lot of them don't ask anything about childhood at all. Social history is usually current living situation, employment, substance use, done.

 

[wolfvgang22]

Come work at the VA. Everyone has PTSD here.

 

[docksan]

I bet it's just from previous evaluators phoning it in on the social history evaluation. If you don't elicit the index event, from a cross-sectional perspective PTSD could look like almost any other psych diagnosis.

Also, globally poor interpersonal functioning as a result of violent/chaotic childhood doesn't have its own specifier. It's lumped in with adult-onset PTSD even though the observable manifestations can be very different.

I work with residents often and my observation is that if unprompted, very few of them will ask about childhood adversity on the intake visit. A lot of them don't ask anything about childhood at all. Social history is usually current living situation, employment, substance use, done.

I start every intake with "Where are you from" and "what was it like growing up" and go from there.

 

[forchinet121]

Calling it depression/anxiety I think is better than calling it bipolar though

 

[Merovinge]

I bet it's just from previous evaluators phoning it in on the social history evaluation. If you don't elicit the index event, from a cross-sectional perspective PTSD could look like almost any other psych diagnosis.

Also, globally poor interpersonal functioning as a result of violent/chaotic childhood doesn't have its own specifier. It's lumped in with adult-onset PTSD even though the observable manifestations can be very different.

I work with residents often and my observation is that if unprompted, very few of them will ask about childhood adversity on the intake visit. A lot of them don't ask anything about childhood at all. Social history is usually current living situation, employment, substance use, done.

The new thing is calling it developmental trauma disorder, I guess that terminology and symptom cluster is gaining more steam than cPTSD. Either way I call it other specified trauma and stress related disorder and then in my assessment note it to be cPTSD or maybe now DTD.

It's actually kind of wild that maybe the single worst thing that can happen in childhood and one of the more common clinical presentations does not have a DSM diagnosis. Hopefully this will change in the nearish future.

 

[MedMan80]

Come work at the VA. Everyone has PTSD here.

the sweet, sweet allure of service connection

 

[WisNeuro]

The new thing is calling it developmental trauma disorder, I guess that terminology and symptom cluster is gaining more steam than cPTSD. Either way I call it other specified trauma and stress related disorder and then in my assessment note it to be cPTSD or maybe now DTD.

It's actually kind of wild that maybe the single worst thing that can happen in childhood and one of the more common clinical presentations does not have a DSM diagnosis. Hopefully this will change in the nearish future.

You haven't jumped on the "complex" PTSD bandwagon, have you?

 

[HemeOncHopeful19]

the sweet, sweet allure of service connection

What was that about a connection? I can’t hear you over the ringing of of my tinnitus (20%)

 

[WisNeuro]

What was that about a connection? I can’t hear you over the ringing of of my tinnitus (20%)

Did they bump up tinnitus? Used to be an auto 10% for the longest time?

 

[HemeOncHopeful19]

Did they bump up tinnitus? Used to be an auto 10% for the longest time?

It probably is, I just made up a number

 

[calvnandhobbs68]

You haven't jumped on the "complex" PTSD bandwagon, have you?

Can you elaborate on this? Are you arguing that there isn’t something different from an trauma perspective for an adult you’re seeing whose trauma was being neglected and beaten for years as a kid vs an adult you’re seeing whose trauma was an IED explosion under his humvee in Afghanistan or getting in a car crash where he watched his wife die and he nearly died?

 

[WisNeuro]

Can you elaborate on this? Are you arguing that there isn’t something different from an trauma perspective for an adult you’re seeing whose trauma was being neglected and beaten for years as a kid vs an adult you’re seeing whose trauma was an IED explosion under his humvee in Afghanistan or getting in a car crash where he watched his wife die and he nearly died?

The research supporting CPTSD as a distinct entity is tenuous, at best. There have been threads over in the psych forum on this over the years.

 

[Celexa]

the sweet, sweet allure of service connection

Lol. I remember when I learned that many of the homeless, substance using vets in the ED and our inpatient units got checks every month that were more than my salary as a resident....

Service connection is many things, and one of them is definitely proof that money doesn't buy happiness, unless you mean the type that comes in a needle.

 

[Candidate2017]

I work with residents often and my observation is that if unprompted, very few of them will ask about childhood adversity on the intake visit. A lot of them don't ask anything about childhood at all. Social history is usually current living situation, employment, substance use, done.

It depends on the setting.

On a psych ward, if you're homeless, use lots of weed and meth, not working, and antagonize everyone around you, then let's just assume your childhood wasn't the best and maybe you've seen some things, and call it a day. Though, it's fair game to quiz (haze) residents and see who can not only come up with the correct DSM-5 diagnosis, but can also add the most modifiers to a given diagnosis.

In a longer term setting, like an outpatient basis, then delving deeper would be more appropriate, as well as fishing out a PTSD diagnosis.

 

[PsyDr]

IMO, I think the allure of PTSD is that it is one of the few diagnoses that have a known cause. It makes the clinician feel smart, and the patient feel as if agency is external.

 

[clausewitz2]

IMO, I think the allure of PTSD is that it is one of the few diagnoses that have a known cause. It makes the clinician feel smart, and the patient feel as if agency is external.

It's like the PANDAS/PANS people. Can't accept your kid might have OCD? Strep must be to blame and the clinician gets to pay themselves on the back for being so up to date and knowledgeable on these things. After about three months I have finally convinced a young woman and her slightly over involved mother that since her symptoms are exactly the same as OCD, it might actually make sense to try some of the treatments that work for OCD instead of vast quantities of antibiotics.

 

[MedMan80]

Lol. I remember when I learned that many of the homeless, substance using vets in the ED and our inpatient units got checks every month that were more than my salary as a resident....

Service connection is many things, and one of them is definitely proof that money doesn't buy happiness, unless you mean the type that comes in a needle.

Not only checks higher than ours, but tax free checks higher than ours

 

[calvnandhobbs68]

IMO, I think the allure of PTSD is that it is one of the few diagnoses that have a known cause. It makes the clinician feel smart, and the patient feel as if agency is external.

If that's what the patient is taking away from it, then the clinician is doing a bad job. My discussion around trauma is never "well bad things happened to you, sorry guess that's just the way it is now and you can blame all the bad things that happen and how you react to them the rest of your life on "trauma" now!". Many people respond very well to the conversation along the lines of "bad things happened in your life, I think this is part of why you feel the way you do right now and we can't discount the impact these bad things had on you, part of your work is likely going to need to include integrating your present self with your prior bad experiences so they don't cause as much negative impact currently" etc.

Patients are also going to just externalize agency and locus of control in general based on their personality. Plenty of people go "it's just my depression, that's just how I am...."

I do agree PTSD is suffering from the same diagnostic creep as basically all other diagnoses at this point as almost any adversity has started being described by some clinicians as "trauma" and the in vogue "microtraumas".

 

[mistafab]

PTSD is both overdiagnosed and underdiagnosed.

It's overdiagnosed in many vets (who are incentivized), and cluster B.

It's underdiagnosed in other settings. We see a lot in our urban area. Not infrequently I pick up PTSD that has been active for 10 or 20+ years with an index event of GSW or witness to murder of family member.

The tough part is many of these folks have no real access to gold standard treatment - but at least the diagnosis alone tends to provide some psychic relief. Had someone today that clearly had the diagnosis. She had been floundering since 2017 post the index event, and had never been diagnosed.

There is almost zero chance she will have access to trauma therapy. But at least she got connected to a trauma support group.

 

[Celexa]

If that's what the patient is taking away from it, then the clinician is doing a bad job. My discussion around trauma is never "well bad things happened to you, sorry guess that's just the way it is now and you can blame all the bad things that happen and how you react to them the rest of your life on "trauma" now!". Many people respond very well to the conversation along the lines of "bad things happened in your life, I think this is part of why you feel the way you do right now and we can't discount the impact these bad things had on you, part of your work is likely going to need to include integrating your present self with your prior bad experiences so they don't cause as much negative impact currently" etc.

Patients are also going to just externalize agency and locus of control in general based on their personality. Plenty of people go "it's just my depression, that's just how I am...."

I do agree PTSD is suffering from the same diagnostic creep as basically all other diagnoses at this point as almost any adversity has started being described by some clinicians as "trauma" and the in vogue "microtraumas".

Yes. This aligns much more with the majority of my patient encounters. Undoubtedly there are a small group of patients who make trauma a central part of their identity and that's just as pathological as every other example of someone making a specific diagnosis the core of their identity. But much more frequently the diagnosis provides an explanation, not an excuse. My version of the conversation is very similar to yours. Acknowledgement of the impact their experiences have had on them is validating when paired with a message that it doesn't have to define them. I talk about the fight or flight reflex and how parts of our brain that keep us alive can become over reactive and I talk about treatment options including both meds and therapy. These are often patients who have shown great resilience in their lives and want to get better.

I do adhere to a fairly strict definition of a criterion A trauma; but the rates of childhood sexual abuse, domestic violence, and gun violence are incredibly high. The minute you start looking for it you find it.

 

[WisNeuro]

PTSD is both overdiagnosed and underdiagnosed.

It's overdiagnosed in many vets (who are incentivized), and cluster B.

It's underdiagnosed in other settings. We see a lot in our urban area. Not infrequently I pick up PTSD that has been active for 10 or 20+ years with an index event of GSW or witness to murder of family member.

The tough part is many of these folks have no real access to gold standard treatment - but at least the diagnosis alone tends to provide some psychic relief. Had someone today that clearly had the diagnosis. She had been floundering since 2017 post the index event, and had never been diagnosed.

There is almost zero chance she will have access to trauma therapy. But at least she got connected to a trauma support group.

If you are near a VA, oftentimes some of the psychologists have a side private practice. You can check with teh state psych association and see if they have a listserv that you can post a message on, asking about providers who deliver things like PE and CPT.

 

[PsyDr]

It's like the PANDAS/PANS people. Can't accept your kid might have OCD? Strep must be to blame and the clinician gets to pay themselves on the back for being so up to date and knowledgeable on these things. After about three months I have finally convinced a young woman and her slightly over involved mother that since her symptoms are exactly the same as OCD, it might actually make sense to try some of the treatments that work for OCD instead of vast quantities of antibiotics.

I think as humans, we prefer to know a cause. The entire spectrum of external causes, internal causes, and sheer bad luck is where psychiatry and psychology live.

If that's what the patient is taking away from it, then the clinician is doing a bad job.

That's not how I meant it. I was more interested in the idea that PTSD is tacitly caused by something external. This external cause is different than most psychiatric diagnoses.

"I feel this way because something happened"= easier to hear.

"I feel this way because I am thinking incorrectly" OR "There is a chemical factor outside of anyone's control that can happen at any moment to anyone."= a bit harder to hear.

It's like when patients spend 9milllion hours asking if it is them or the medication.

 

[Stagg737]

To add to the original point, sometimes patients just lie or intentionally avoid reporting those traumas.

I do a fairly extensive psych ROS with my intakes since my outpatient work is mostly as a consultation clinic which includes going into full criterion for PTSD if they meet criterion A. Found out from my office mate (my psychologist counterpart for this clinic) that I missed a case a couple of months ago because the patient never told anyone until she started seeing him. I'm very gentle about initial trauma discussions and catch a fair amount of trauma-related disorders, so was pretty surprised that patient (with years of repeated sexual abuse as a child) didn't even mention it to me.

A lot of times it is d/t bad patient interviewing by the clinician, but some patients just want to avoid it at all costs until they're ready to bring it up, or sometimes bring it up accidentally.

 

[Merovinge]

"I feel this way because something happened"= easier to hear.

"I feel this way because I am thinking incorrectly" OR "There is a chemical factor outside of anyone's control that can happen at any moment to anyone."= a bit harder to hear.

I don't know that's actually the case. I think knowing that "if it were not for this horrible thing that happened I would be fine" can be a lot harder than "I was going to have this problem regardless of what events happen in my life". Realizing that being raped has caused more problems than you want to believe, even if it it has a real path towards healing, is not a straightforward sell. I think the substance use rates following these events pretty clearly show that this is not some easy to hear diagnosis that people are running towards.

 

[WisNeuro]

I don't know that's actually the case. I think knowing that "if it were not for this horrible thing that happened I would be fine" can be a lot harder than "I was going to have this problem regardless of what events happen in my life". Realizing that being raped has caused more problems than you want to believe, even if it it has a real path towards healing, is not a straightforward sell. I think the substance use rates following these events pretty clearly show that this is not some easy to hear diagnosis that people are running towards.

I don't think it's much different than other MH disorders once they reach the moderate level of severity. They all show pretty similar comorbidity rates with SUD. Also complicated in that increased substance use is both predisposing risk factor and consequent issue in trauma exposure. But again, it's pretty much the same thing across the mood/anxiety spectrum.

 

[smalltownpsych]

The new thing is calling it developmental trauma disorder, I guess that terminology and symptom cluster is gaining more steam than cPTSD. Either way I call it other specified trauma and stress related disorder and then in my assessment note it to be cPTSD or maybe now DTD.

It's actually kind of wild that maybe the single worst thing that can happen in childhood and one of the more common clinical presentations does not have a DSM diagnosis. Hopefully this will change in the nearish future.

I refer to it as complex developmental trauma so I guess I cover both parts of that. Not sure if it should be a distinct diagnostic entity or just part of conceptualizing and planning treatment which is really what I do now. One problem with our diagnostic categories, and especially something like this, is that there is so much within group variance and between groups overlap that it makes it hard to draw the lines.

 

[Merovinge]

I refer to it as complex developmental trauma so I guess I cover both parts of that. Not sure if it should be a distinct diagnostic entity or just part of conceptualizing and planning treatment which is really what I do now. One problem with our diagnostic categories, and especially something like this, is that there is so much within group variance and between groups overlap that it makes it hard to draw the lines.

I mean that is also true for MDD, schizophrenia, GAD, etc. I don't feel that is what should keep us away from having a concrete diagnostic syndrome of developmental trauma. This area NEEDS a lot more research, it feels like one of the biggest gaps in present mental health to me (admittedly a bit biased working in child/adolescent psychiatry).

I think the fact that medications are unlikely to be indicated for it's treatment is the biggest reason we don't see more research, and that's obviously a garbage reason to not research it further. Can you imagine identifying specific genetic changes associated with developmental trauma and CRISPRing them back to the default? Nothing against the horror of sickle cell disease (which will hopefully be curable very soon for the world due to CRISPR) but that type of breakthrough would do more for the world than almost anything other than reliable nuclear fusion.

 

[smalltownpsych]

Agreed and these patients are my specialty. Just because it is difficult to research or that the research is limited because of lack of pharma money doesn’t mean that we shouldn’t delve into it more. I do diverge from the thought that there is likely to be a medical treatment to “fix” kids like this, mainly because the neurobiological system is not dysfunctional, rather it is responding as designed to the environment and treating it involves reshaping the environment. Unfortunately, some of the behavioral and social patterns that evolve lead to societal/interpersonal responses that reinforce these same problems. Of course, it does make a lot of sense that a psychologist would argue that the psychosocial is more important and that the psychiatrist would argue that the physiological is where the emphasis should be. 😁

 

[Mad Jack]

Agreed and these patients are my specialty. Just because it is difficult to research or that the research is limited because of lack of pharma money doesn’t mean that we shouldn’t delve into it more. I do diverge from the thought that there is likely to be a medical treatment to “fix” kids like this, mainly because the neurobiological system is not dysfunctional, rather it is responding as designed to the environment and treating it involves reshaping the environment. Unfortunately, some of the behavioral and social patterns that evolve lead to societal/interpersonal responses that reinforce these same problems. Of course, it does make a lot of sense that a psychologist would argue that the psychosocial is more important and that the psychiatrist would argue that the physiological is where the emphasis should be. 😁

While there may be no cure for PTSD from a pharmacological perspective, medication may blunt some of the responses that typically crop up secondary to traumatic events and exposures. This allows individuals to interrupt the feedback loop of trigger>physiologic response>behavioral response and can make it easier for them to engage in therapy or their day-to-day life in a manner that allows them to ultimately overcome their trauma. Even if I were able to Eternal Sunshine someone's memories they would still have that underlying adaptive circuitry that can only be undone with therapeutic approaches.

Groundhog day in my consult clinic:

Pt has a history of either "depressionanxiety" or "bipolar".

I perform my evaluation.

Pt has textbook PTSD.

I discuss my findings with patient. Patient says something like "I've always suspected that but no one had ever [diagnosed me/confirmed that/talked to me about it]"

These are often satisfying visits because I can make a real difference (by getting them towards the right types of therapy and the right meds--including reducing antipsychotic use for the bipolar or psychotic disorder they do not have) but also, fill me with confusion that in the 10, 15, 20, 40 years since the index trauma(s) I'm the first person making the diagnosis. I was fortunate to receive very good trauma training including working with some excellent trauma specialist therapists. Is there a general reluctance or education gap that makes people hesitant to diagnosis PTSD? I'm genuinely baffled.

Now excuse me, I am off to perform a chart exorcism to try and banish another inaccurate bipolar diagnosis for a patient with an extensive childhood trauma history.

I run into many similar cases in my day-to-day. One thing that I try to do is remember that condition changes over time, and I wasn't there on the day they were diagnosed with bipolar disorder, depression, anxiety, etc. Trauma predisposes toward all of these, and it's entirely possible they did have a psychotic episode which resolved with their current regimen and also have trauma, so I keep it in the back of my mind as I taper things down. More often than not, however, "bipolar disorder" is either low distress tolerance and poor coping mechanisms leading to externalizing behaviors in the setting of personality disorders or personality disorder traits, plus or minus trauma. I'd say 60% of my patients have a significant degree of trauma in their life and would benefit from treatment for it, but only a fraction of them have true PTSD that would meet DSM-5 criteria.

 

[Celexa]

To add to the original point, sometimes patients just lie or intentionally avoid reporting those traumas.

I do a fairly extensive psych ROS with my intakes since my outpatient work is mostly as a consultation clinic which includes going into full criterion for PTSD if they meet criterion A. Found out from my office mate (my psychologist counterpart for this clinic) that I missed a case a couple of months ago because the patient never told anyone until she started seeing him. I'm very gentle about initial trauma discussions and catch a fair amount of trauma-related disorders, so was pretty surprised that patient (with years of repeated sexual abuse as a child) didn't even mention it to me.

A lot of times it is d/t bad patient interviewing by the clinician, but some patients just want to avoid it at all costs until they're ready to bring it up, or sometimes bring it up accidentally.

Yes. A pattern I've noticed is when I sense a discrepancy between the description of the patients anxiety symptoms, and the degree of impairment they are reporting/affect in front of me (I've had multiple people who gave fairly anodyne stories about why they decided to seek help, who broke down into tears under very gentle questioning about what their day to day is like), PTSD is very likely.

I also encounter a number of patients who don't currently meet criteria for PTSD, but clearly did so in the past for a substantial period of time. Saying they have PTSD is inaccurate and can muddle the picture in terms of treatment choices for other conditions; at the same time the trauma is still relevant but in our parlance saying "history of PTSD" makes it sounds like an active problem, and there are no remission specifiers in the DSM like there are for MDD or substance use disorders. I agree with the above conversation about needing more research into these disease entities and the natural history of the condition.

 

[Ceke2002]

What about a middle ground conceptualisation of stuff like PTSD, Developmental Trauma etc and Bipolar Disorder, Psychotic Disorders etc? For example I have a family history of depression, anxiety and psychotic disorders (mostly schizophrenia), and I grew up with what I like to describe as 'Sh***ty Childhood Syndrome'. So does that mean the mental health issues I've experienced are entirely biologically based, trauma based, or maybe a combination of the two. If I am now fully stabilised thanks to long term therapy work, does that mean I don't need to monitor for potential return of clinical depression (or similar) symptoms & be prepared to go back on medication if a depressive episode does occur? These are rhetorical questions, I'm more asking about taking a middle ground approach that considers things like trauma and biological disease processes as stuff that can co-occur without it being one or the other. Just interested to here professional thoughts on this.

 

[Mad Jack]

What about a middle ground conceptualisation of stuff like PTSD, Developmental Trauma etc and Bipolar Disorder, Psychotic Disorders etc? For example I have a family history of depression, anxiety and psychotic disorders (mostly schizophrenia), and I grew up with what I like to describe as 'Sh***ty Childhood Syndrome'. So does that mean the mental health issues I've experienced are entirely biologically based, trauma based, or maybe a combination of the two. If I am now fully stabilised thanks to long term therapy work, does that mean I don't need to monitor for potential return of clinical depression (or similar) symptoms & be prepared to go back on medication if a depressive episode does occur? These are rhetorical questions, I'm more asking about taking a middle ground approach that considers things like trauma and biological disease processes as stuff that can co-occur without it being one or the other. Just interested to here professional thoughts on this.

It's almost always a little of one and a little of the other, rarely is illness purely genetic or environmental

 

[Ceke2002]

It's almost always a little of one and a little of the other, rarely is illness purely genetic or environmental

Thanks for the reply. Do you have any recommended books, articles, or studies I can access on this? I just randomly feel like falling down a rabbit hole of studying something.

 

[Mad Jack]

Thanks for the reply. Do you have any recommended books, articles, or studies I can access on this? I just randomly feel like falling down a rabbit hole of studying something.

A lot of these resources are behind paywalls, but it's pretty well studied. Here's a few systematic reviews

A systematic review on comorbid post-traumatic stress disorder in schizophrenia - PubMed

Post-traumatic stress disorder (PTSD) appears to commonly co-occur with schizophrenia, which is widely considered the most disabling mental illness. Both conditions share neurological risk factors, and present with symptoms that are superficially similar, complicating diagnostic accuracy. The...

pubmed.ncbi.nlm.nih.gov

Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment

During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World ...

www.ncbi.nlm.nih.gov

Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations

Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD). The current paper examines evidence for two explanations of this comorbidity. First, that the comorbidity reflects overlapping symptoms ...

www.ncbi.nlm.nih.gov

Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature - PubMed

Bipolar disorder and PTSD commonly co-occur and result in greater symptom burden than either condition alone. Few published treatment strategies exist for patients with both conditions.

pubmed.ncbi.nlm.nih.gov

 

[psychma]

The professor who trained me on PTSD criteria was a PTSD researcher from the VA. His index criteria for trauma were quite strict and he taught me to use the CAPS-5 as a diagnostic tool. It’s pretty hard to tick all of the boxes. The most common response to trauma is resilience. Some people have experienced trauma, don’t meet criteria for PTSD and have other disorders. Just a thought to ponder.

 

[Celexa]

The professor who trained me on PTSD criteria was a PTSD researcher from the VA. His index criteria for trauma were quite strict and he taught me to use the CAPS-5 as a diagnostic tool. It’s pretty hard to tick all of the boxes. The most common response to trauma is resilience. Some people have experienced trauma, don’t meet criteria for PTSD and have other disorders. Just a thought to ponder.

Do you see anyone here arguing that everyone with trauma has PTSD? Something like 90% of the patients I see have traumatic histories. Most of them don't have PTSD. I started the thread to talk about the ones who clearly do and don't get diagnosed.

We've had many discussions on this board about the uniqueness of the VA and how institional incentives there push patients towards attaining a PTSD diagnosis. That incentive is absent in other populations.

 

[psychma]

Do you see anyone here arguing that everyone with trauma has PTSD? Something like 90% of the patients I see have traumatic histories. Most of them don't have PTSD. I started the thread to talk about the ones who clearly do and don't get diagnosed.

We've had many discussions on this board about the uniqueness of the VA and how institional incentives there push patients towards attaining a PTSD diagnosis. That incentive is absent in other populations.

I sense defensiveness.

 

[romanticscience]

The professor who trained me on PTSD criteria was a PTSD researcher from the VA. His index criteria for trauma were quite strict and he taught me to use the CAPS-5 as a diagnostic tool. It’s pretty hard to tick all of the boxes. The most common response to trauma is resilience. Some people have experienced trauma, don’t meet criteria for PTSD and have other disorders. Just a thought to ponder.

Also, some with a primary depressive disorder exhibit the whole syndrome without criterion A (1) and half of individuals with various anxiety disorders report symptoms sufficient for a diagnosis of PTSD (2).

1. Bodkin, J. A., Pope, H. G., Detke, M. J., & Hudson, J. I. (2007). Is PTSD caused by traumatic stress?. by traumatic stress? J Anxiety Disord 2007; 21:176–182

2. Engelhard IM, Arntz A, Van den Hout MA: Low specificity of symptoms on the post-traumatic stress disorder (PTSD) symptom scale: a comparison of individuals with PTSD, individuals with other anxiety disorders and individuals without psychopathology. Br J Clin Psychol 2007; 46:449–45

 

[psychma]

Also, some with a primary depressive disorder exhibit the whole syndrome without criterion A (1) and half of individuals with various anxiety disorders report symptoms sufficient for a diagnosis of PTSD (2).

1. Bodkin, J. A., Pope, H. G., Detke, M. J., & Hudson, J. I. (2007). Is PTSD caused by traumatic stress?. by traumatic stress? J Anxiety Disord 2007; 21:176–182

2. Engelhard IM, Arntz A, Van den Hout MA: Low specificity of symptoms on the post-traumatic stress disorder (PTSD) symptom scale: a comparison of individuals with PTSD, individuals with other anxiety disorders and individuals without psychopathology. Br J Clin Psychol 2007; 46:449–45

There is a lot of heterogeneity amongst symptoms which has been a criticism.