636,120 Ways to Have Posttraumatic Stress Disorder

In an attempt to capture the variety of symptoms that emerge following traumatic stress, the revision of posttraumatic stress disorder (PTSD) criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has expanded to include additional symptom presentations. One...

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Bibliographic Details
Published in:Perspectives on psychological science 2013-11, Vol.8 (6), p.651-662
Main Authors: Galatzer-Levy, Isaac R., Bryant, Richard A.
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Anxiety disorders. Neuroses
Biological and medical sciences
Classification
Heterogeneity
Medical sciences
Nosology. Terminology. Diagnostic criteria
Post-traumatic stress disorder
Posttraumatic stress disorder
Psychiatric disorders
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Revisions
Symptoms
Techniques and methods
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Summary:In an attempt to capture the variety of symptoms that emerge following traumatic stress, the revision of posttraumatic stress disorder (PTSD) criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has expanded to include additional symptom presentations. One consequence of this expansion is that it increases the amorphous nature of the classification. Using a binomial equation to elucidate possible symptom combinations, we demonstrate that the DSM-IV criteria listed for PTSD have a high level of symptom profile heterogeneity (79,794 combinations); the changes result in an eightfold expansion in the DSM-5, to 636,120 combinations. In this article, we use the example of PTSD to discuss the limitations of DSM-based diagnostic entities for classification in research by elucidating inherent flaws that are either specific artifacts from the history of the DSM or intrinsic to the underlying logic of the DSM's method of classification. We discuss new directions in research that can provide better information regarding both clinical and nonclinical behavioral heterogeneity in response to potentially traumatic and common stressful life events. These empirical alternatives to an a priori classification system hold promise for answering questions about why diversity occurs in response to Stressors.
ISSN:1745-6916
1745-6924
DOI:10.1177/1745691613504115