The British Journal of Psychiatry

Gaudiano & Zimmerman1 conclude that psychotic symptoms in post-traumatic stress disorder (PTSD) are associated with comorbid conditions, especially major depressive disorders, and that their results therefore do not support the existence of a psychotic subtype of PTSD. However, they did not evaluate certain factors that might be responsible for misinterpretation of their results. First, they did not report the severity of post-traumatic and depressive symptoms. It is possible that patients with PTSD without comorbid depressive disorder had a milder post-traumatic disorder and consequently less probability of presenting with psychotic symptoms. Second, in clinical practice the congruence of delusions and hallucinations with traumatic events seems to be distributed across a continuum: at one extreme there is complete congruence with trauma and at the other there are exuberant and bizarre symptoms similar to those described in schizophrenia. The elucidation of the possible existence of a psychotic subtype of PSTD must necessarily include the development of adequate instruments to measure severity and congruence of psychotic symptoms in ‘ non-psychotic’ conditions (e.g. mood and anxiety disorders), as well as their biological correlates.