Since the 1980s, there has been a rise in post-traumatic stress disorder (PTSD) diagnoses. Some argue this is a result of society recognizing the seriousness of trauma. Other clinicians are concerned we’re overdoing it. But is PTSD overdiagnosed?

It’s estimated that 60 of every 100 men (60%) and 5 of every 10 women (50%) experience trauma at least once in their lifetime. Furthermore, some estimates claim that between 7-8% of the population struggles with PTSD. With that, 8 million Americans struggle with it at any given time. ¹

Throughout this article, we’ll seek out if these numbers are accurate and whether or not you may struggle with another type of anxiety disorder.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a form of anxiety that appears after a traumatic event. What defines a traumatic event is very open-ended. However, common forms of trauma include combat, childhood abuse, sexual assault, and abusive relationships. ²

While everyone experiences PTSD differently, common symptoms include:

• Avoiding places, events, or objects that remind of traumatic event
• Distorted emotions (i.e. guilt or blame)
• Easily startled
• Flashbacks (reliving the traumatic event)
• Frightening thoughts
• Insomnia (difficulty sleeping)
• Irritable outbursts
• Loss of interest in activities you once enjoyed
• Negative feelings about oneself
• Nightmares

Compared to other mental conditions, PTSD is relatively easy to diagnose as there’s a preceding event. However, some clinicians believe that we’re overdiagnosing PTSD and some individuals may struggle with another form of anxiety, such as a social anxiety disorder.

Is PTSD Overdiagnosed?

One of the biggest arguments for PTSD being overdiagnosed is the fact that most patients have a natural reaction to trauma. As you can imagine, when one goes through a traumatic event, they’re likely to feel distressed from the experience.

Researchers have looked into the matter and concluded, “The conflation of stress with trauma – and of trauma with PTSD – has become rife. This is the most convincing explanation for overdiagnosis.” ³

Researchers agree that in some areas, such as a military setting, PTSD is likely to be underdiagnosed. However, in other areas, such as the general society, they believe there’s been an increased pressure on services to make a diagnosis.

One of the aspects guiding this over-diagnosis is “compensation culture.” In other words, our society has reached a point where any vulnerability to trauma is considered PTSD.

Still, the team also recognizes that our society may be more understanding of trauma than it was thirty years ago. Furthermore, we may have also developed better tools to identify and properly treat PTSD.

How is PTSD Diagnosed?

As of this time, the DSM-V states that a PTSD diagnosis must meet the following criteria: ⁴

• Stressor (A) – A person must have experienced, witnessed, learned, or had indirect exposure to a traumatic event.

• Intrusion Symptoms (B) – A person must experience nightmares, flashbacks, emotional distress, or physical reactivity following trauma.

• Avoidance (C) – A person must avoid either thoughts/feelings or external reminders of the traumatic event.

• Negative Changes in Cognition (D) – A person must have experienced at least two negative symptoms (see above) from the trauma.

• Changes in Arousal and Reactivity (E) – Certain reactive symptoms (i.e. irritability, difficulty sleeping, etc.) must have either begun or worsened after trauma.

• Duration (F) – Symptoms have lasted for more than 1 month.

• Functionality (G) – Symptoms have made it difficult to complete day-to-day tasks.

• Exclusion (H) – Symptoms are not a response to other medication, substance abuse, or another health condition.

Concerns with Diagnostic Criteria

Researchers concluded this criteria isn’t specific enough for a proper diagnosis. In their own words: “On this basis, we must reclaim the diagnosis of PTSD for what it is – a profound and severe response to catastrophic events – and not a spectrum of reactions to trauma or everyday life.”

However, some researchers believe PTSD is actually underdiagnosed. Admittedly, there’s only so much research to claim PTSD is overdiagnosed. Furthermore, some evidence indicates that many adults meet the PTSD diagnosis criteria but haven’t received any help. ⁵

Obviously, underdiagnoses also raise much concern. For example, those with PTSD are much more likely to attempt suicide than the general population. ⁶

Final Word

PTSD is a serious mental health condition that shouldn’t be taken lightly. If you or someone you love has experienced signs or symptoms of PTSD following a traumatic event, you should seek out help.

The purpose of this study was to indicate whether or not PTSD was overdiagnosed and, in turn, people weren’t receiving the treatment they truly needed. While the study remains inconclusive, we can only hope more research will identify the mental stress of traumatic experiences.

References

¹ Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Section 1, A Review of the Literature. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207192/

² Mann SK, Marwaha R, Torrico TJ. Posttraumatic Stress Disorder. 2024 Feb 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644555.

³ Tully J, Bhugra D, Lewis SJ, Drennan G, Markham S. Is PTSD overdiagnosed? BMJ. 2021 May 5;373:n787. doi: 10.1136/bmj.n787. PMID: 33952508.

⁴ Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

⁵ Grasso D, Boonsiri J, Lipschitz D, Guyer A, Houshyar S, Douglas-Palumberi H, Massey J, Kaufman J. Posttraumatic stress disorder: the missed diagnosis. Child Welfare. 2009;88(4):157-76. PMID: 20405781; PMCID: PMC4158713.

⁶ Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Arch Suicide Res. 2010;14(1):1-23. doi: 10.1080/13811110903478997. PMID: 20112140.