Usefulness and validity of post-traumatic stress disorder as a psychiatric category

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Gillian Mezey, senior lecturer in forensic psychiatry (gmezey@sghms.ac.uk)a,
Ian Robbins, consultant clinical psychologistb

^a Forensic Psychiatry, St George's Hospital Medical School, Jenner Wing, London SW17 0RE
^b Traumatic Stress Service, South West London and St George's Mental Health NHS Trust, Clare House, St George's Hospital, London SW17 0QT

Correspondence to: G Mezey

Accepted 29 June 2001

Post-traumatic stress disorder has attracted controversy and scepticism since its first appearance in the Diagnostic and Statistical Manual of Mental Disorders in the 1980s.1 Over the years the diagnostic criteria have been refined and revised, but the causal relation between the diagnosis and an external trauma has remained fundamentally unchanged. Post-traumatic stress disorder is associated with clinically important distress that transcends ordinary misery and unhappiness as well as with disruption and impairment of daily functioning. We argue that the diagnosis is valid and important for both patients and doctors.

Summary points

Post-traumatic stress disorder is a valid and useful diagnosis but is not the only psychiatric response to trauma

Prevalence in the general population is estimated between 1% and 7.8%

The disorder is associated with high rates of psychiatric comorbidity and impairment in social and occupational functioning

Post-traumatic stress disorder can be differentiated from other psychiatric diagnoses by biochemical, neuroanatomical, and phenomenological characteristics

Concerns about the diagnosis in victims of chronic and lifelong trauma could be resolved by further refinement of the diagnostic criteria

Social or psychiatric diagnosis?

One of the main criticisms of the diagnosis of post-traumatic stress disorder is that it has been constructed out of sociopolitical ideas rather than psychiatric ones.2 However, most psychiatric conditions reflect changes in human thinking over time.3 For example, changes in the political climate and fashion were more influential than advances in medical research in altering the categorisation of homosexuality as a disease. Social factors such as poverty also contribute to mental illness, stress, suicide, family integration, and substance misuse.4 Sociocultural factors may determine whether the person is able to cope with the potentially traumatising experiences that set the stage for the development of post-traumatic stress disorder.5