Investigators Develop Diagnostic Guidelines for Post-Traumatic Stress Disorder
Diagnosing mental disorders is often challenging, but may be especially difficult in post-traumatic stress disorder (PTSD) due to the high rates of comorbidity between PTSD and other psychiatric disorders. Moreover, there are several problematic diagnostic questions: How do mental health care providers distinguish symptoms of agoraphobia from avoidance symptoms of PTSD? How do we differentiate overlapping symptoms of PTSD and depressive disorders? And, when are hallucinations symptomatic of PTSD versus an independent psychotic disorder? In order to answer these and other important diagnostic questions, investigators in this study interviewed 115 male Veterans with combat-related PTSD and depressive disorders who were enrolled in a randomized clinical trial comparing self-management therapy versus psycho-educational group therapy.
As a result of this study, investigators offer guidelines for the differential diagnosis of Veterans with PTSD. For example, avoidance of certain places or situations should not necessarily count as a symptom of both agoraphobia and PTSD. Assessment of the reason for the avoidance behavior should determine which disorder better accounts for it. Hallucinations that were strongly related to the theme of a traumatic experience were considered to be a re-experiencing symptom of PTSD (flashback) rather than an indication of a separate psychotic disorder. Therefore, clinicians should be aware that those suffering from PTSD might present with symptoms that initially point to other diagnoses, and that mistaken diagnoses can have detrimental effects. Of particular concern is the possibility that PTSD-related hallucinations may be seen as a primary psychotic process. Investigators believe that the guidelines they offer can lead to greater reliability in the diagnosis of PTSD and related comorbid conditions.
Schillaci J, Yanasak E, Adams J, Dunn N, Rehm L, and Hamilton J. Guidelines for differential diagnoses in a population with post-traumatic stress disorder. Professional Psychology: Research and Practice February 2009; 40(1):39-45.
This study was funded by HSR&D. Dr. Dunn is part of HSR&D's Houston Center for Quality of Care and Utilization Studies. Dr. Dunn also is part of the VA Medical Center in Houston, as are Drs. Schillaci and Hamilton.