Criteria for Posttraumatic Stress Disorder

Controversy has haunted the diagnosis of posttraumatic stress disorder (PTSD) ever since its appearance in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association [APA], 1980). At the outset, psychiatrists opposed to the inclusion of the diagnosis in DSM-III argued that the problems of trauma-exposed people were already covered by combinations of existing diagnoses. Ratifying PTSD would merely entail cobbling together selected symptoms in people suffering from multiple disorders (e.g., phobias, depression, personality disorder) and then attributing these familiar problems to a traumatic event. Moreover, the very fact that the movement to include the diagnosis in DSM-III arose from Vietnam veterans’ advocacy groups working with anti-war psychiatrists prompted concerns that PTSD was more of a political or social construct, rather than a medical disease discovered in nature. Although the aforementioned two concerns have again resurfaced in contemporary debates about PTSD, additional issues have arisen as well. For example, the concept of a traumatic stressor has broadened to such an extent that today the vast majority of American adults have been exposed to PTSD-qualifying events. This state of affairs is drastically different from the late 1970s and early 1980s when the concept of trauma was confined to catastrophic events falling outside the perimeter of everyday experience. As the chapters in this volume illustrate, early twenty-first-century scholars are raising fresh questions about the syndromic validity of PTSD. Many traumatologists regard skepticism about the syndromic validity of PTSD as motivated by either a malicious agenda to silence the voices of survivors, or by sheer ignorance of the psychiatric consequences of overwhelmingly horrific experience. In contrast, scholars working outside mainstream traumatology do not consider the diagnosis as exempt from critique. They write from diverse perspectives, and hail from varied disciplines, such as anthropology (e.g., Antze & Lambek, 1996; Young, 1995, 2001, 2002), sociology (e.g., Lembcke, 1998), history (e.g., Burkett, 2001; Burkett & Whitley, 1998; Dean, 1997; Shephard, 2001, 2002), psychiatry (e.g., Bracken & Petty, 1998; Reisner, 2003; Satel, 2003; Summerfield, 1999, 2000, 2001), and philosophy (e.g., Hacking, 1998, 1999, pp. 125–162). Rather than review these wide-ranging critiques of PTSD, this chapter focuses on several conceptual problems arising from the diagnostic criteria themselves.