How Do We Know If Someone Has PTSD?

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-- From a VA website

Post-traumatic stress disorder is one of the most troubling legacies of our wars in Afghanistan and Iraq. Hundreds of thousands of troops and their families are affected. How do we ensure the help – both medical and financial – is going to those who need it? Well, that requires, one would think, a uniform yardstick so folks working for the Department of Veterans Affairs can separate the deserving from the rest.

But according to a new paper in the Journal of Traumatic Stress, that’s not the case:

One hundred thirty-eight Veterans Affairs mental health professionals completed a 128-item Posttraumatic Stress Disorder (PTSD) Practice Inventory that asked about their practices and attitudes related to disability assessment of PTSD. Results indicate strikingly wide variation in the attitudes and practices of clinicians conducting disability assessments for PTSD. In a high percentage of cases, these attitudes and practices conflict with best-practice guidelines. Specifically, 59% of clinicians reported rarely or never using testing, and only 17% indicated routinely using standardized clinical interviews. Less than 1% of respondents reported using functional assessment scales.

This wide variety of PTSD-diagnosing tools represents “a concerning finding” that ” fuels questions about adequacy of the disability examination,” the study concludes.

Former VA officials say they were perplexed by what they see as the lack of rigor in such assessments. “Given the amount of money at stake, the importance this has for veterans, and fact that we have well-established procedures for conducting such evaluations, it is frankly quite puzzling and disappointing that the VA is not using these procedures,” says Dr. Chris Frueh, a professor of psychology at the University of Hawaii, and a former VA PTSD clinician in South Carolina.

The VA said the paper is “useful in underscoring the need for a reliable, consistent and valid standardized diagnostic assessment of PTSD,” but added that “while there’s a lot of variation discovered in this study, it does not seem to have affected the rates of which we diagnose PTSD.” VA officials say their agency “is putting forth an enormous effort to understand, diagnosis and treat PTSD.”