|Type of paper:||Essay|
|Categories:||Medicine Post traumatic stress disorder|
The psychic impact caused by trauma has been known for nearly three millennia. For instance, epic poems such as The Iliad and The Odyssey speak of psychic scars caused by different forms of trauma like war. However, regardless of this long-standing knowledge, it is not until 40 years ago that the Diagnostic and Statistical Manual of Mental Disorders (DSM) acknowledged post-traumatic disorder (PTSD) as a mental condition. Though the diagnosis of PTSD has greatly evolved ever since, it has continued to generate intense controversies. Looking into history, the conceptualization of PTSD has also changed severally over the years. For instance, during Freud's time, an individual's character deficits were seen as the primary cause of PTSD. During World War II, PTSD was seen as a normal reaction to exposure to persistent combat. After the war, more attention was given to extreme stressor as the major cause of PTSD. Besides, the definition and criteria of diagnosis of the condition keep changing. To this end, critics have argued that the revision process of the DSM lacks transparency, integrity, and representation. Possible influence by pharmaceutical companies has also been cited. In 2017, the National Institute of Mental Health estimated that 3.6% of adults in the United States have PTSD (NIH). However, advocates argue that PTSD remains underdiagnosed and undertreated. In this light, this paper seeks to discuss the causes and extent of the under-diagnosis of PTSD.
It is estimated that clinicians miss the diagnosis of PTSD almost 90% of the time (Scheeringa). This figure was reached following an analysis of studies carried out in South Africa and the United States. Several reasons have been cited for the high incidence of under-diagnosis of the condition. The DSM-5 requirement for the diagnosis of PTSD is that the symptoms must be connected to a past event. This requirement has been blamed for the high prevalence of under-diagnosis (Scheeringa). The fact that most symptoms are internalized, and victims try to avoid reminders of traumatic events complicates diagnosis further (Scheeringa). Besides, as discussed below, conflicting opinions among stakeholders have also significantly contributed to the problem. Underdiagnosis of PTSD leads to insufficient treatment, and hence continued distress for the victims. It might also lead to misinterpretation of the symptoms. Therefore, there is a need to address the issue of the underdiagnosis of PTSD exhaustively.
The debate on the assessment, openness, and neurobiology of PTSD has raged on since its introduction as a mental condition. Owing to this debate, conflicting opinions have emerged over time regarding the clinical utility of PTSD. Conflicting interests between insurance companies, clinicians, governments, and victims' groups have made the situation worse. According to a study carried out in 2014, the controversy is most prevalent in military contexts (Fisher 1). The author argues that conflicting opinions often lead to struggles regarding the prevalence rates. While the PTSD criteria changes were meant to integrate the newly acquired knowledge regarding the condition and hence improve diagnosis and treatment, there are worries that the changes could lead to occupational, clinical, and legal consequences among veterans (Guina, Welton and Broderick 43). It has also been argued that many veterans do not seek treatment even after experiencing symptoms of PTSD. As such, no diagnosis is made, and hence the condition is underdiagnosed (Fisher 8).
Underdiagnosis in Other Populations
Other than the military, there are concerns that PTSD is grossly under-diagnosed in different populations. Substance users are among the most under-diagnosed individuals. According to literature, there exists a direct link between substance use disorder and PTSD. Statistics show that the prevalence of PTSD in this population is almost three times higher than that of the general population. Moreover, it has been shown that if PTSD is untreated, the outcome of SUD treatment is bound poor. Unfortunately, the under-diagnosis of the condition is prevalent, a factor that ultimately affects the health outcomes in this population. A 2014 study used 432 substance use disorder patients and 475 control participants to determine the extent of diagnosis of PTSD in this population (Gielen, Havermans and Tekelenburg 17734). The researchers determined that PTSD remains largely undetected, especially when no standardized tool is used. They also established that clinical judgment is subject to bias, and hence validated assessment tools should always be used to diagnose PTSD in substance use disorder treatment facilities. The researchers concluded that the under-diagnosis of PTSD in this population potentially hurts their treatment outcome (Gielen, Havermans and Tekelenburg 17734).
A 2009 study established that maltreated children are also among the most under-diagnosed populations regarding PTSD (Grasso, Boonsiri and Lipschitz 157). According to the authors, this occurs due to a lack of information to supplement the child and parent report. History of experiencing or witnessing a traumatic event is required in the diagnosis of PTSD. When reports of such experiences are missing, as is the case among maltreated children, diagnosis of PTSD is missed (Grasso, Boonsiri and Lipschitz 157). The authors, therefore, called for more collaboration between protective service workers and mental health professionals to improve the diagnosis of PTSD in maltreated children.
Claims of Overdiagnosis
While there exists overwhelming evidence confirming that PTSD is underdiagnosed, some studies have claimed that the condition is overdiagnosed instead. In one such study, the researcher concentrated on literature that discusses issues of PTSD following the start of the U.S.-led war in Iraq and Afghanistan (Fisher 6). Using contestations used by veteran's advocates, public officials, and researchers, the author made several assertions. First, the author argued that some public officials view PSTD as an overly generalized condition. The diagnostic category is also often falsified by veterans. Looking at the issue from this perspective, the author held that PTSD is overdiagnosed (Fisher 5). Critics have also argued that though PTSD is a real thing, it has become so overstretched that it has become part of the culture. Resultantly, other problems are easily mistaken for PTSD. The definition of PTSD as per DSM, as well as the required criteria for diagnosis, have also been blamed for the overdiagnosis of the condition (Dobbs 66).
While PTSD is a significant mental health problem today, its treatment is hampered by underdiagnosis. As shown in the paper, the condition is grossly underdiagnosed, especially among servicemen and maltreated children. Though some critics have argued that the condition has become overstretched, leading to overdiagnosis, the evidence pointing towards underdiagnosis is overwhelming. Therefore, to save patients from more distress, there is a need for concerted efforts to improve the diagnosis of PTSD.
Dobbs, David. "The post-traumatic stress trap." Scientific American 300.4 (2009): 64-69. <https://www.jstor.org/stable/26001304>.
Fisher, Michael P. "PTSD in the US military, and the politics of prevalence." Social Science & Medicine 115 (2014): 1-9. <https://www.sciencedirect.com/science/article/pii/S0277953614003451>.
Gielen, Nele, et al. "Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is." European Journal of psychotraumatology 3.1 (2012): 17734. <https://www.tandfonline.com/doi/abs/10.3402/ejpt.v3i0.17734>.
Grasso, Damion, et al. "Posttraumatic stress disorder: The missed diagnosis." Child Welfare 88.4 (2009): 157. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158713/>.
Guina, Jeffrey, et al. "DSM-5 criteria and its implications for diagnosing PTSD in military service members and veterans." Current psychiatry reports 18.5 (2016): 43. <https://link.springer.com/article/10.1007/s11920-016-0686-1>.
NIH. "Post-Traumatic Stress Disorder (PTSD)." November 2017. NIH. 11 March 2020. <https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.shtml>.
Scheeringa, Michael S. "Why PTSD Is Under-Recognized, Part I: The Upside Down." 14 February 2018. Psychology Today. 11 March 2020. <https://www.psychologytoday.com/us/blog/stress-relief/201802/why-ptsd-is-under-recognized-part-i-the-upside-down>.
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