Veterans Today: Stressing The Point: When is a PTSD Claim Legitimate, and When Is It Not?

Expanded version of an article first published in the November 1995 issue of For the Defense, the monthly journal of the Defense Research Institute, Chicago, Illinois. Partial Reprint of a 1996 article on PTSD. Stressing the Point: When is a Post Traumatic Stress Disorder Claim Legitimate, and When Is It Not. PTSD is a condition that arises from exposure to life thraetening circumstances and it was first diagnosed among some of the survivors of wartime combat. Throughout W.W.I the syndrome was known as Shell Shock and was thought to be primarily motivated by the soldier's effort at self preservation. In World War II it was called War Neurosis or Combat Fatigue. The modern diagnosis of PTSD, a by-product of the Vietnam War, falls within the general DSM-IV category of Anxiety Disorders, sub category of Stress Disorders. Listed below are the DSM-IV's diagnostic criteria for PTSD, followed by my detailed discussion  of these criteria. Like pregnancy, PTSD is defined as something one has or does not have: for medical legal purposes, there are no shades of PTSD gray, even though in actuality and in some current research, the condition is viewed more in terms of a gradient of symptoms. Medical-legally, however, one is either in or out of the diagnosis, according to whether or not the individual fulfills the six specific, detailed criteria, the so-called A-F criteria. In a nutshell, the A criter ia require an individual to have been exposed to a life-threatening circumstance. Earlier incarnations of the DSM used a broad and overly inclusive yardstick, outside of the range of normal human experience, but this criterion was considered too loose and was easily abused in its interpretation. With the recent publication of DSM-IV, the "A" criteria have been tightened considerably. The new wording requires that the person experienced, witnessed or was confronted with an event or events that involved actual or threatened death. Even the secondary phrase, or serious injury, or a threat to the physical integrity of self or others implies a grave degree of bodily threat. It was the intention of the DSM-IV subcommittee to tighten the "A"criteria so that it conformed more closely to the kind of actual life-threatening circumstances, such as combat, where PTSD was first observed. In essence, the trauma must be sufficiently severe that it ruptures a person's bubble of invulnerability. Most of the time people avoid thinking about the possibility of death in order to carry on their daily lives without constant, high levels of anxiety. PTSD victims re-experience the trauma over and over again, in a variety of different ways. This results from the psyche's effort to master overwhelming perceptual stimuli.