PTSD - or not PTSD?
Psychiatric
experts are often asked about the presence or absence of a diagnosis of
post-traumatic stress disorder. Of course, it's not just an academic question -
damages for PTSD tend to be higher than for related or indeed overlapping
conditions such as anxiety and depression.
So
how does the psychiatrist draw the distinction between a diagnosis of PTSD on
the one hand, and other psychiatric conditions- whether that be anxiety,
depression, adjustment disorder, etc etc- on the other.
The
key point to remember here is that it's not just the symptoms. What the patient
tells us, and how they present at interview, is only part of the story. In the
case of PTSD, the symptoms and clinical examination are not in themselves
enough.
The
putative traumatic event has to be sufficiently severe to allow a diagnosis of
PTSD to be considered. Dr Martin Williams, an American psychologist has
recently considered this point in some detail in an article on his
website.
He usefully reminds us about
the qualities of the trauma (so called criterion A) required for PTSD, as
defined in the Diagnostic and Statistical Manual of the American Psychiatric
Association, 4th ed., the DSM IV.
Criterion A says that the
trauma has to involve "actual or threatened death or serious injury, or
a threat to the physical integrity of self or others".
So, if you have been
unfairly dismissed from your job, you may get depression. You get anxiety. You
may get alcoholism. But, by definition, you can't get PTSD.
DG 4/3/07
