Usefulness and validity of post-traumatic stress disorder as a psychiatric category

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Abstract
Post-traumatic stress disorder has attracted controversy and scepticism since its first appearance in the Diagnostic and Statistical Manual of Mental Disorders in the 1980s.1 Over the years the diagnostic criteria have been refined and revised, but the causal relation between the diagnosis and an external trauma has remained fundamentally unchanged. Post-traumatic stress disorder is associated with clinically important distress that transcends ordinary misery and unhappiness as well as with disruption and impairment of daily functioning. We argue that the diagnosis is valid and important for both patients and doctors. #### Summary points Post-traumatic stress disorder is a valid and useful diagnosis but is not the only psychiatric response to trauma Prevalence in the general population is estimated between 1% and 7.8% The disorder is associated with high rates of psychiatric comorbidity and impairment in social and occupational functioning Post-traumatic stress disorder can be differentiated from other psychiatric diagnoses by biochemical, neuroanatomical, and phenomenological characteristics Concerns about the diagnosis in victims of chronic and lifelong trauma could be resolved by further refinement of the diagnostic criteria One of the main criticisms of the diagnosis of post-traumatic stress disorder is that it has been constructed out of sociopolitical ideas rather than psychiatric ones.2 However, most psychiatric conditions reflect changes in human thinking over time.3 For example, changes in the political climate and fashion were more influential than advances in medical research in altering the categorisation of homosexuality as a disease. Social factors such as poverty also contribute to mental illness, stress, suicide, family integration, and substance misuse.4 Sociocultural factors may determine whether the person is able to cope with the potentially traumatising experiences that set the stage for the development of post-traumatic stress disorder.5 The diagnosis of post-traumatic stress disorder was developed partly as …