PTSD definition questioned, Another hurdle for Survivors

In a March 21 article on NewScientist.com, we found the following opener:

Doubt cast on definition of PTSD
13:06 21 March 2007
NewScientist.com news service
Roxanne Khamsi

Many patients suffering from severe depression "test positive" for post-traumatic stress disorder, regardless of whether or not they have actually experienced trauma, a new study reveals.

Based on this finding, researchers say that psychiatrists need to identify more specific criteria for PTSD. Doing so, they suggest, will "save the diagnosis" from becoming too general and therefore misleading.

Our first thought was,"Gee does Ms. Khamsi have any idea how hard it is to get a therapist to consider starting with a preliminary diagnosis of PTSD and not depression when the precipitating event is not in the immediate past?" Probably not.

There is a lack of solid evidence that post-traumatic stress is biologically different from depression not triggered by a specific event. "I really don't think we know" what distinguishes them biologically. Dr. Alexander Bodkin of Harvard's McLean Hospital

Bravo Sierra! According to this article, the study comprised of "101 patients with severe depression" 78% tested affirmative for PTSD but 36% also tested affirmative for PTSD without evidence of trauma. It is the opinion of this writer that self-reporting of trauma is a tricky business at best. Consider the shame factor alone in cases of sexual assault of all definitions; there is a mountain of clinical evidence supporting the theory that sexual assault is the most under reported contributing factor in mental health caseloads. Therapists routinely report that clients will not disclose this type of trauma without a carefully crafted basis of therapist/client trust.

Barbara Olasov Rothbaum, director of the trauma and anxiety recovery programme at Emory University School of Medicine in Atlanta, Georgia holds a more reasonable position. She believes "it is crucial to distinguish PTSD as unique because 'the treatment is very different' for this disorder than for other forms of depression."

Indeed it is. Clients treated with some anti-depressants have reported an increase in symptoms of anxiety, the very symptom which is a daily undercurrent in PTSD. PTSD survivors are more prone to a condition called "hypervigilance", hyper meaning heightened and vigilance in this instance would be analogus to a part of the client's brain standing watch, continuously. Anti-depressants aggrivate this symptom.

It is difficult enough for PTSD survivors to overcome their very real barriers to treatment, convince a therapist to address PTSD first and leave discussion of depression for when there is a sufficient trust bond. This usually takes place when clients who are fed up with being told they are just depressed or bi-polar or borderline personality disorder(ed) finally recognize what their own symptoms are telling them.

We believe that the sampling of 101 clients who are severely depressed is not a useful scientific sampling. The observations of Dr. Bodkin & his colleagues are just so much crappiccino. Depression may very well be a secondary symptom, generated by the fatique hypervigilance and anxiety produce over the long term of a client's experiences. But "depression" in all it's various incarnations should never be the catch-all first diagnosis in self reporting clients.

PTSD is a very real, treatable condition which stems from the experience of trauma. It has a beginning, a well documented set of symptoms and is according to the newest research and treatment trials, curable. For PTSD survivors, that's great news!

Tags: PTSD, post traumatic stress disorder, depression, bodkin, rothbaum