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The British Journal of Psychiatry (2008) 192, 3–4. doi: 10.1192/bjp.bp.107.043083

Editorial

Problems with the post-traumatic stress disorder diagnosis and its future in DSM–V Gerald M. Rosen, Robert L. Spitzer and Paul R. McHugh

Summary Significant issues challenge the diagnosis of post-traumatic implications for clinical practice and for those who revise stress disorder (PTSD). Yet, applications of the PTSD ‘model’ criteria in the DSM–V. have been extended to an increasing array of events and

Declaration of interest human reactions across diverse cultures. These issues have None.

Gerald Rosen (pictured) is a Clinical Professor with the Department of Psychology at the University of Washington, and with the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Robert Spitzer is Professor of Psychiatry in the Department of Psychiatry at Columbia University. He led the development of the American Psychiatric Association’s Diagnostic and Statistical Manual, 3rd edition (DSM–III) and its revision (DSM–III–R). Paul McHugh is presently University Professor of Psychiatry at Johns Hopkins School of Medicine and Professor in the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University. He was Psychiatrist-in-Chief at Johns Hopkins Hospital, 1975–2001.

Post-traumatic stress disorder (PTSD) will undoubtedly be revised in DSM–V. When considering changes, committee members will be faced with the fact that since its inception in 1980 little about PTSD has gone unchallenged. In this context, we focus on several core issues regarding the PTSD diagnosis.

Specific aetiology?

Unlike other diagnoses in the DSM that were agnostic to aetiology, PTSD was defined as a disorder that arose after a specific set of traumatic stressors. Thus, the origins of the definition of PTSD rest on the assumption of a specific aetiology (Criterion A). This assumption, already questionable,1 has been undermined by reports that the disorder can develop after a variety of non-life­ threatening events (e.g. divorce, financial difficulties).2 Further, recent studies have demonstrated the frequent occurrence of PTSD symptoms among people with depression who had not experienced Criterion A life stressors,3 and among people with social phobias who respond to failed performance situations.4

Even when an individual encounters horrific, life-threatening events (Criterion A), studies