PTSD Diagnostic Criteria: Where’s the Human Factor?

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.

© Copyright 2010 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Shania


    December 21st, 2010 at 10:24 AM

    If and when they stop treating patients like ‘subjects’ and understand that each one has his/her own needs,they will be able to treat them better.

  • BettyJoe


    December 21st, 2010 at 12:18 PM

    Shania, I totally agree with you. I like the goodtherapy website because they believe people are more than their problems. Keep up the good posts!

  • Victor


    December 23rd, 2010 at 9:57 AM

    The same thing can affect different people differently and hence I think it makes sense to see how that person has been affected due to the issue on hand and not just a generic treatment for the particular problem.

  • Lydia


    December 23rd, 2010 at 3:13 PM

    Therapists have to be more objective than I think that we give them credit for. They cannot give the best treatment options possible if they are not willing to keep their eyes open and see the real individualities that many of their patients are going to bring to the table. I think that this is going to be true no matter whether the patient presents with PTSD or depression or whatever. Sure studies are going ot make generalities but I think that the professional eye will better be able to discern and keep those geberalities at bay.

  • Robyn


    December 24th, 2010 at 8:05 AM

    PTSD is a disorder that is still being studied and therefore there are bound to be cases where doctors or therapists feel like they are grasping at straws to come to a clear diagnosis about what is going on. But if you take your treatment seriously and are honest with the therapist there is a far greater chance that you will be able to receive the most clear cut treatment plan.

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Title   Content   Author is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on