Official diagnostic criteria—the symptoms and qualities that are internationally used to identify mental health issues—are rarely without controversy. Recent attention has centered around the proposed removal of narcissism from a list of personality disorders. But a Boston University Medical Center study in the upcoming issue of Psychological Bulletin examines diagnostic criteria for a psychological condition far more prominent: post-traumatic stress disorder. For the study, researchers embarked upon a comprehensive review of literature concerning trauma and the human psychological response to trauma, then compared that information with diagnostic standards for PTSD. Their conclusion? “Diagnostic criteria for PTSD fall short.”
Here’s the problem researchers identified: diagnostic criteria tends to define “trauma” based on what happened, rather than how it affected the person. So certain experiences are ‘de facto’ traumas: war, violent attack, sexual assault, etc. But people are complex: we react to various situations in various ways. A person may need years of therapy to deal with the psychological aftermath of a situation that doesn’t fall in the traditional realm of “trauma.” Likewise, someone may experience a recognized form of trauma, but deal with it in a way that does not present itself like typical PTSD. But the current diagnostic criteria for PTSD includes very little room for subjective emotions or reflections on an experience: it’s based on what happened and how a person acts afterward, not how they think and feel.
Labeling a condition such as PTSD can be (but doesn’t have to be) an important step in a person’s treatment and recovery process. But psychology isn’t an exact science, and diagnosis isn’t as straightforward as running a blood test. “Trauma should be defined as the interaction between the individual and his or her environment, and all parts of an individual’s response should be considered,” said Brian P. Marx, Ph.D., the study’s co-author. This human factor is essential to the realm of therapy and counseling, where treatment is based on the unique qualities of each individual’s experience, personality, and past. That subjective, human factor should be a part of diagnosis as well.
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