316 CHAPTER 7
Problems With the DSM-IV-TR Diagnostic Criteria
for Posttraumatic Stress Disorder
The diagnosis of PTSD was introduced into the DSM in the third edition (American
Psychiatric Association, 1980), thereby offi cially recognizing the persistent mental
suffering of some trauma victims. However, the diagnosis of PTSD is controversial
for several reasons:- The distress and suffering experienced by people months after a traumatic event
are not necessarily pathological, but including of them as criteria in the DSM
defi nes the experiences as pathological (McHugh & Triesman, 2007; McNally,
2007; Spitzer, First, & Wakefi eld, 2007; Summerfi eld, 2001). - Many of the symptoms of PTSD (e.g., problems concentrating and sleeping,
irritability) overlap with those of depression and anxiety, and therefore the ap-
parent symptoms of PTSD may in fact be symptoms of those other disorders
(Bodkin et al., 2007; Spitzer, First, & Wakefi eld, 2007). - The original criteria for PTSD involved traumatic events far outside those
normally experienced during the ordinary course of life, such as war, rape,
Table 7.18 • PTSD Facts at a Glance
Prevalence- Among adults in the United States, approximately 8% develop PTSD, although this number
varies depending on political events.
Comorbidity- About 80% of those with PTSD also have another psychological disorder, most commonly a
mood disorder, substance use disorder, or other anxiety disorder (Kessler et al., 1995).
Onset- Symptoms usually begin within 3 months of the traumatic event, although people may go
months or years before symptoms appear. - However, people who develop PTSD usually show symptoms in the immediate aftermath of
the trauma; approximately 80% of people with acute stress disorder go on to develop PTSD
(Harvey & Bryant, 2002).
Course- Duration of the symptoms varies. About half of those with PTSD recover within 3 months, whereas
others continue to have persistent symptoms for more than a year after the traumatic event. Still
others have symptoms that wax and wane.
Gender Differences- Women who have been exposed to trauma develop PTSD more often than do men (American
Psychiatric Association, 2000; Tolin & Foa, 2006), although males are more likely be victims
of trauma (Tolin & Foa, 2006).
Cultural Differences- Across cultures, people with PTSD may differ in the particular symptoms they express (e.g.,
more intrusive symptoms versus more arousal symptoms) depending on the coping styles
that are encouraged in a given culture (Marsella, Friedman, & Spain, 1996). - Black Americans, who are more likely to live in high-crime neighborhoods, develop PTSD at a
higher rate than do white Americans (Himle et al., in press).
Source: Unless otherwise noted, information in the table is from American Psychiatric Association, 2000.