There are 636,120 ways to have post traumatic stress disorder

The latest version of the American Psychiatric Association’s (APA) controversial diagnostic code – “the DSM-5” – continues the check-list approach used in previous editions. To receive a specific diagnosis, a patient must exhibit a minimum number of symptoms in different categories. One problem – this implies someone either has a mental illness or they don’t.

To avoid missing people who ought to be diagnosed, over time the criteria for many conditions have expanded, and nowhere is this more apparent than in the case of post traumatic stress disorder (PTSD). Indeed, in their new analysis of the latest expanded diagnostic criteria for PTSD, Isaac Galatzer-Levy and Richard Bryant calculate that there are now 636,120 ways to be diagnosed with PTSD based on all the possible combinations of symptoms that would fulfil a diagnosis for this condition.

First defined as a distinct disorder in 1980, for many years PTSD was diagnosed based on a patient exhibiting a sufficient number of various symptoms in three categories: reexperiencing symptoms (e.g. flashbacks); avoidance and numbing symptoms (e.g. diminished interest in activities); and arousal symptoms (e.g. insomnia). For the latest version of the DSM, a new symptom category was introduced: alterations in mood and cognition (e.g. increased shame). This means a diagnosis of PTSD is now met according to the patient having a minimum of 8 of 19 possible symptoms across four categories (or criteria), so long as these appear after they witnessed or experienced an event involving actual or threatened harm.

Putting these various diagnostic permutations into the statistical grinder, Galatzer-Levy and Bryant arrive at their figure of 636,120 ways to be diagnosed with PTSD. This compares to 79,794 ways based on DSM-IV – the previous version of the APA’s diagnostic code. The net has not widened in this fashion for all conditions – for example the criteria for panic disorder have tightened (there were 54,698 “ways” to be diagnosed with panic disorder in DSM-IV, compared with 23,442 ways in DSM-5).

Galatzer-Levy and Bryant believe the PTSD scenario exemplifies the problem with using a set of pre-defined criteria to identify whether a person has a mental health problem or not. In the pursuit of increasing diagnostic reliability, the code loses its meaning in a fog of heterogeneity. The authors fear that despite the increasing diagnostic complexity, people who need help are still missed, while others continue to be misdiagnosed. They believe this could be the reason why the research into risk factors for PTSD, and into the effectiveness of interventions for the condition, tends to produce such highly varied results.

The ideal situation, according to Galatzer-Levy and Bryant, is for our understanding and description of mental health problems to be based on empirical data – in this case about how people respond to stress and trauma. They say a useful approach is to use statistical techniques that reveal the varieties of ways that people are affected over time – a complexity that is missed by simple symptom check-lists. For instance, Galatzer-Levy and Bryant say there are at least three patterns in the way people respond to stressful events – some cope well and show only short-lived symptoms; others struggle at first but recover with time; while a third group continue struggling with chronic symptoms.

“Such an empirical approach for identifying behavioural patterns both in clinical and nonclinical contexts is nascent,” the authors conclude. “A great deal of work is necessary to identify and understand common outcomes of disparate, potentially traumatic, and common stressful life events.”


Isaac R. Galatzer-Levy and Richard A. Bryant (2013). 636,120 Ways to Have Posttraumatic Stress DisorderPerspectives on Psychological Science

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

5 thoughts on “There are 636,120 ways to have post traumatic stress disorder”

  1. Post Traumatic Stress Disorder diagnosis have been occurring more and more throughout the years. PTSD is a long lasting anxiety disorder that develops from an extreme physical or psychological trauma. Intense feelings of horror and helplessness are cases of extreme traumas. When PTSD was first discovered it was only people associated with people in the military. Now like you said there are many other ways to have PTSD. With the development in technology and education it has been known many other things can cause PTSD, such as natural disasters, personal experiences, and any emergency workers. Many people are being misdiagnosed with this disorder. We should base the data with the empirical data before diagnosing someone that does not have a disorder like Galatzer-Levy and Bryant stated and it will help focus on the people that actually do have this disorder.

  2. I would completely agree that within the last decade or so, their has been way more psychological disorder diagnosis' than need be. It is a good choice for them to change some criteria in the DSM-5. I must argue the fact that they are now making it harder to be treated if necessary. They now say a person has to have 8 out of 19 possible symptoms across four categories in order to be diagnosed with PTSD. Lets say a person has ongoing flashbacks of a traumatic experience, with no control over when and how they form in the mind. It is so severe that it ruins that persons everyday functionalities and relationships, yet that is the only symptom she has for the psychiatrist to check off. Would they consider that PTSD? They should since it is stopping the person from living their normal life. How can a doctor dismiss a patient with such uncontrolable turmoil from getting help because they don't meet the criteria?

  3. Post traumatic stress disorder an anxiety disorder that develops in response to an extreme physical or psychological trauma. It used to be that military combat was the primary source for this disorder. I agree, more and more cases seem to come about each year. More than 5 million adults experience PTSD episodes in a given year. But only 3 things should determine this. The person frequently recalls the event unwantedly and ultimately is intrusive on the persons daily life. Second, the person avoids stimuli or situations that might trigger the memories of the experience. And thirdly, the person experiences sleep disturbances, have trouble focusing and are prone to outbursts. These should be things determining the presence of this disorder.

  4. we all have our own minds and bodies. however our stream of consciousness and percepiveness is uniquely our own. PTSD is onset by traumatic and very stressful events. to say there is any set number of ways to develope this disorder i feel is nonsense. everyone handles stress and traumtic events in our own ways and should seek treatment so one does not harm thy self or anyone in contact with you

  5. Post-Traumatic Stress Disorder or PTSD is usually defined as an anxiety disorder that usually lasts a long time. This disorder is caused in response to an extreme psychological or physical trauma. These traumas can be by feelings of horror, or if a person feels threatened or helpless in some way. It is most common with, or associated with people who are in the military and usually veterans who were in military combat have a higher chance of PTSD. Like it was mentioned above, a person would frequently recall an event or flashbacks, would avoid stimulus and situations that trigger those flashbacks and lastly would go through numbness of emotional response. This article does a good job of talking about the impacts of PTSD and description of it. It is, however, seen in others that have not experienced war trauma before. Also, not everyone who experiences extreme stress will develop PTSD. It all depends on the magnitude of the trauma itself and how it psychologically effects every person.

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