The Importance of Accurate Diagnosis of Post Traumatic Stress.


As a specialist in trauma and Post Traumatic Stress, I read and research constantly for new information and treatment options in order to provide the best possible options for each person I have the fortune of working with.
 
The difficulty can be is that most individuals with PTSD suffer from other mental disorders as well. Studies of the prevalence of PTSD in large samples have found the following mental disorders are most likely to be co-morbid with PTSD:
 
  • Major Depression
  • Substance Use Disorders
  • Dysthymia – persistent mild depression
  • Agoraphobia
  • Obsessive-Compulsive Disorder
  • Generalised Anxiety Disorder
  • Panic Disorder
  • Somatisation Disorder – extreme anxiety about physical symptoms such as pain or fatigue
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Adjustment Disorder
  • Phobias
 
It can be challenging to determine whether overlapping symptoms are best conceptualised as being a part of the PTSD constellation of symptoms or whether they should be attributed to another disorder. Differential diagnosis can be especially difficult when disorders other than PTSD are preceded by exposure to traumatic stress.
 
Despite some symptom overlap between PTSD and other disorders, PTSD has a number of unique features that distinguish it from other disorders. DSM-5 provides specific differential diagnosis guidelines in order to help clinicians assign the most appropriate diagnoses. I know there is much controversy over the DSM, however it is useful to have some form of benchmark to work from.
 
The following elements are useful in distinguishing symptoms of PTSD from symptoms of other disorders:
 
  • PTSD symptoms start or get worse after exposure to a traumatic event.
  • Stimuli reminiscent of traumatic events that activate PTSD symptoms are often pervasive and wide ranging, as opposed to singular or highly specific as in the case of phobias.
 
Disorders other than PTSD may be caused, in part, by exposure to traumatic stress. Although stressor exposure is part of the PTSD diagnostic criteria, PTSD is by no means the only mental disorder that may develop in the wake of trauma exposure. Examples of disorders that may develop after or be exacerbated by trauma exposure include adjustment disorder and phobias. Other highly prevalent disorders, such as depression and panic disorder, may also be potentiated by a traumatic stressor.
 
It is important to look at the guidelines for making a differential diagnosis of PTSD versus other conditions that are commonly associated with traumatic stress exposure. PTSD can be distinguished from these disorders by its defining symptom criteria (i.e., to meet criteria for PTSD, individuals must demonstrate a symptom profile that is consistent with the guidelines for PTSD). Additionally, exposure to traumatic stress is a requirement for a diagnosis of PTSD; in contrast, for disorders such as depression, panic disorder and phobias, although symptoms may be associated with a traumatic event, this is not a requirement.
 
This is why it is important to gather information from varying sources using a variety of methods in order to ensure an accurate diagnosis which will enable the best possible treatment for all symptoms for each individual.

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