Is PTSD overdiagnosed?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n787 (Published 05 May 2021) Cite this as: BMJ 2021;373:n787
- John Tully, clinical associate professor in forensic psychiatry1,
- Dinesh Bhugra, emeritus professor of mental health and cultural diversity2,
- Stephanie J Lewis, clinical research training fellow and clinical lecturer in child and adolescent psychiatry2 3,
- Gerard Drennan, consultant clinical psychologist and head of psychology and psychotherapy, behavioural and developmental psychiatry3,
- Sarah Markham, visiting researcher and mental health service user2
- 1Faculty of Medicine and Health Sciences, University of Nottingham
- 2Institute of Psychiatry, Psychology and Neuroscience, King’s College, London
- 3South London and Maudsley NHS Foundation Trust
- Correspondence to: J Tully John.Tully{at}nottingham.ac.uk, S J Lewis stephanie.j.lewis{at}kcl.ac.uk
Yes—John Tully and Dinesh Bhugra
Post-traumatic stress disorder (PTSD) is a serious and uncommon condition resulting from severe trauma, but it has unhelpfully become an umbrella term incorporating other disorders and normal reactions to stress.
PTSD emerged after the Vietnam war in the Diagnostic and Statistical Manual of Mental Disorders (version III, 1980) as a clinical diagnosis arising after exposure to terrifying, usually life threatening events, such as combat, rape, or confinement to a concentration camp. Symptoms such as reliving experiences (“flashbacks”) and hypervigilance were relatively discriminating.
Subsequently, the threshold for diagnosis was lowered—since 1987 the manual has allowed for indirect experience of trauma1—and rates of diagnosis rose. This was critiqued in The BMJ 20 years ago,2 and diagnosis of PTSD has continued to burgeon throughout Western society.
Estimates of lifetime population prevalence are now about 7% in the US (26 million cases) and 5% in other high income countries.3 In the UK, estimates include presence of PTSD in 1 in 13 youths (with common precipitants including “bullying by peers”4) and in mothers after 4% of all births.5
Why is PTSD overdiagnosed?
So, has the true incidence of PTSD really spiralled out of control, or has it simply become overdiagnosed? Context is important. In military settings, some data suggest that PTSD is possibly underdiagnosed,6 although not all veterans are exposed to combat, and those who are don’t all develop PTSD.789 The developing world, with limited psychiatric resources, may also be underdiagnosing the condition.
Elsewhere, alarming estimates are better explained by another contemporary construct: concept creep. …
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