In an article published in the BMJ, experts debated as to whether diagnoses of post-traumatic stress disorder (PTSD) are surging in Western society due to real trauma, or whether it is simply being overdiagnosed.
Some clinicians are concerned that diagnoses of PTSD have increased throughout Western society since the late 1980s.
PTSD is a serious and uncommon condition resulting from severe trauma, but is has come to mean an umbrella term encompassing other disorders and normal reactions to stress, argued John Tully at the University of Nottingham and Dinesh Bhugra at King’s College London’s Institute for Psychiatry, Psychology & Neuroscience (IoPPN).
Estimates of lifetime population prevalence are now around 7% in the US (26 million cases) and at 5% in other high income countries. In the UK, PTSD is estimated to be in 1 in 13 youths and in mothers after 4% of all births.
In military settings, there may be an underdiagnosis of PTSD, they acknowledged, as well as in the developing world due to limited psychiatric resources.
But in other settings, they argue that PTSD is often conflated with normal responses to difficult situations, which has led to increased pressure on services to make this diagnosis.
“The conflation of stress with trauma—and of trauma with PTSD—has become rife. This is the most convincing explanation for overdiagnosis,” they wrote.
This “concept creep” they argue, may also involve “compensation culture” and vested interests of the “trauma industry” as factors, they said. Am alternative explanation could be that psychiatry and society have become more accepting of trauma, and so give more leeway to diagnosis and treatment.
At a public health level however, they believe this approach is problematic as, “resources are finite, and a line must be drawn somewhere as to what level of symptoms meets criteria.”
PTSD misdiagnosis also risks other more common conditions, such as depression, anxiety disorder, and personality disorders, not being appropriately treated, while trivialising PTSD risks the medicalisation of everyday life, devaluing resilience and protective social factors, they warn.
“On this basis, we must reclaim the diagnosis of PTSD for what it is—a profound and severe response to catastrophic events—and not a spectrum of reactions to trauma or everyday life,” they conclude.
However Stephanie Lewis, Sarah Markham and Gerard Drennan at King’s IoPPN and the South London and Maudsley NHS Foundation Trust, contend that there is compelling evidence showing that PTSD is much more commonly underdiagnosed, which has concerning implications.
They say that PTSD has clear guidelines for diagnosis, and there is no evidence to suggest that it is being overdiagnosed – and rather the opposite.
“Large epidemiological studies representative of the population have found that less than half of adults and two fifths of young people who meet criteria for PTSD have sought help from any health professional,” they wrote.
“These findings fit with our professional experience that people with PTSD often find it difficult to seek help—for example, because of avoidance symptoms, concerns about stigma, or fear that there may be no effective treatment,” they write.
Additionally, only a fraction of people with PTSD who access health services receive a diagnosis, they added.
They warned that underdiagnosis is concerning because, compared to those without PTSD adults who meet the criteria are over six times more likely to attempt suicide, and 10 times for young people with PTSD. However, treatment can be effective.
They argued that underdiagnosis to PTSD should be reduced, and access increased to service for diagnosis and treatment.
“Prioritising these actions now may prove particularly timely because the COVID-19 pandemic may have exacerbated the underdiagnosis of PTSD,” they concluded.
Source: Medical Xpress
Journal information: Is PTSD overdiagnosed? BMJ (2021). www.bmj.com/content/373/bmj.n787
