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Is PTSD Over-Diagnosed?

April 22, 2009
by Daniel Guarnera
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Thanks to NAADAC Government Relations Intern Mara Gray for guest-blogging this post!

What exactly is PTSD? The DSM-IV-TR defines Post Traumatic Stress Disorder as an anxiety disorder following a traumatic event, in which the person frequently re-experiences the event, shows avoidance or numbing of general responsiveness, and has an increased arousal level (such as not being able to sleep or overall irritability). These symptoms have to be present at least one month.

Now when we think of PTSD, what comes to mind? Soldiers from Vietnam or those returning from Iraq. Substance abuse. Homelessness. But have these images led us to misunderstand what PTSD really is? Richard J. McNally, a psychologist at Harvard University, argues that might be the case in a recent article called “Soldiers' Stress: What Doctors Get Wrong about PTSD” published in the April edition of Scientific American Magazine.

Photo taken by Sgt. Timothy Kingston and accessed from's Photostream. It is used with a Creative Commons license.

McNally says that readjustment issues are bound to occur after the traumatic events that war imposes on our servicemembers. However, are clinicians too quick to offer a diagnosis of PTSD when, some of the responses returning veterans exhibit are part of the natural healing process? For example, Maj. Matt Stevens, even two years after returning from duty, has dreams about his experience in war. He’s quoted as saying, “One night I dreamt I was bird-watching with my wife. When we saw a bird, she would lift her binoculars, and I would lift my rifle and watch the bird through the scope. No thought of shooting it. Just how I looked at birds.” Should a dream such as this be dealt with as a disorder, or is it a “healthy” attempt to by Stevens to understand his past and integrate it into his everyday life?

The article argues further that PTSD has often been over-diagnosed. For example, a study in 1990 reported that 31% of veterans experienced PTSD at some point in their lives. A follow-up study found that “clinically significant impairment,” the level required for diagnosis, was found in only 11% of those veterans. In 2006, a different study found that of 12,000 troops, only 4.3% of soldiers developed symptoms calling for a diagnosis. However, many advocates and clinicians still cite the 31% number as the standard rate of PTSD in veterans.



Daniel Guarnera

Daniel Guarnera is the Director of Government Relations for NAADAC, The Association for...

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