An Easier PTSD Diagnosis

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A U.S. soldier on patrol in eastern Afghanistan.

Being diagnosed with post-traumatic stress disorder could get easier following the upcoming annual meeting of the American Psychiatric Association where the group’s fifth edition of its Diagnostic and Statistical Manual (DSM-5) is slated to be released in San Francisco.

DSM-5 has new guidelines and criteria for many psychiatric diagnoses. There is already lots of controversy about this latest revision.

Here I’d like to focus on the diagnosis with most relevance for military service members and veterans: PTSD.

Essentially the new criteria make it easier to meet the criteria for PTSD, by eliminating so called Criterion A-2, and by adding symptoms that make a PTSD diagnosis more likely.

Criterion A-2 is the requirement that people experience extreme fear, helplessness and horror at the time of a traumatic incident.

This is a good change.

When the bomb goes off or they are shot at, most well-trained service members do not experience helplessness or horror. They are well-trained; they drag their wounded buddies to safety, lay down suppressing fire, and continue with the mission.

But they still may have intrusive memories: seeing their friend’s heads blown off, or the dead children in the vicinity of the bomb blast.

In the past, they did not strictly meet the criteria for PTSD, so they might get a related diagnosis like anxiety disorder, not otherwise specified (NOS).

Added elements recognized in the PTSD diagnosis include: cognitive difficulties; depressive symptoms; and strong body reactions to smells or other triggers reminding them of the event.

The big questions to me are

— How and when these changes will affect the disability system?

— Will the military and VA adopt the new changes? If so, when?

— If adopted, will veterans who previously did not meet the earlier criteria for PTSD be re-evaluated?

To add to the complexity, many service members receive multiple disability evaluations. They may receive a medical evaluation board (MEB). Then they may receive one or more TDRL (temporary disability retirement list) evaluations through the military. Then another one or more through the Department of Veterans’ Affairs.

Which diagnostic criteria should be used for each evaluation?

According to the APA, the changes are voluntary and to be implemented over time.

However, that’s not a good enough answer for service members and their families stuck amid the disability process.

The PTSD diagnosis has always been surrounded with controversy (proof: I’m hosting a workshop on Controversies in PTSD at the APA).

One controversy that received a lot of attention last year is whether the diagnosis should be changed to Post-Traumatic Stress Injury. I’m in favor of that change. Another one is whether PTSD sufferers should be eligible for a Purple Heart medal. I’m ambivalent on that. It’s grist for a future post.

In the more immediate term, the military needs to decide what, and when, to do in terms of deciding when it will change the criteria. The Army already relaxed its PTSD criteria in April 2012. But more needs to be done. To do right by our troops, the view from here is that both the Pentagon and VA should embrace the new criteria without delay.