© 2008 The Royal College of Psychiatrists
Correspondence |
Post-traumatic stress disorder’s future
Department of Psychiatry, University of Queensland, PO Box 1216, Noosa Heads, Queensland 4567, Australia. Email: cantor98{at}powerup.com.au
Edited by Kiriakos Xenitidis and Colin Campbell
Rosen et al’s editorial1 raised problems associated with criteria that creep into the diagnosis of post-traumatic stress disorder (PTSD). Conditions including grief, relationship problems, dental care, abortion, traumatic television and humiliating events have entered the arena of PTSD. I support their appeal to psychiatrists to adopt a narrower definition, but beg to go further.
The DSM series has been invaluable for taking the science of psychiatry from its infancy to its adolescence of today. However, we now need to look towards maturity when we will use conceptualisations that involve true entities instead of symptom collections. What do we currently mean by PTSD? Both ‘stress’ and ‘traumatic’ are so non-specific they are now virtually meaningless – not to mention the ‘P’ and ‘D’. According to the authors’ concerns, the broadened concept of PTSD might euphemistically be described as ‘Post Something Really Horrible Disorder (PSRHD)’.
Panksepp2 proposed a preliminary taxonomy of distinct emotional modular systems (i.e. core emotions), supported by neuroscientific findings complemented by an evolution-based approach. I suggest that for the high-prevalence conditions comprising most of psychiatry, neuroscience without consideration of evolutionary adaptiveness is plain stupidity, as many of the relevant genes would not have persisted without adaptiveness.
Much of the PTSD bracket relates to the multiple forms of depression (a loss phenomenon) already catered for in the DSM. I have proposed that PTSD should be viewed as a disorder of defence involving extreme fear as the core emotion.3 As such, some improvements to the DSM criteria can easily be accommodated such as differentiating the sleep disturbance associated with depressive ruminations from the listening for the ‘bump in the night’ of PTSD. Criterion C7 (sense of foreshortened future) should be scrapped as it clearly is depressive. Space here does not permit other commonsense improvements (see Cantor,3 pp. 124–28).
The notion of ‘Post Terrible Scare Disorder’ might be a more scientifically valid concept, if lacking in elegance as a term.
REFERENCES
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1
- Rosen GM, Spitzer RL, McHugh PR. Problems with the post-traumatic
stress disorder diagnosis and its future in DSM–V. Br J
Psychiatry 2008; 192: 3
–4.
[Abstract/Free Full Text] 2 - Panksepp J. Affective Neuroscience: The Foundations of Human and Animal Emotions. Oxford University Press, 1998 . 3
- Cantor C. Evolution and Posttraumatic Stress: Disorders of Vigilance and Defence. Routledge, 2005 .
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