Abstract
Follow up of post-traumatic stress disorder symptoms in Australian servicemen hospitalized in 1942–1952
In their paper Drs Burgess Watson and Daniels conclude, on the basis of interviews with 12 servicemen who responded to a newspaper advertisement, that eight had ‘symptoms satisfying a diagnosis of PTSD at the time of the study’ [1]. They then deduce that post-traumatic stress disorder (PTSD) symptoms were probably common and underreported during and after World War II. The study design and sample size call for caution in interpretation of their data.
The criteria used for diagnosing PTSD relied on participants’ endorsement of symptoms from the Impact of Events Scale (Revised; IES). The presence of these symptoms is not sufficient to satisfy the criteria for a diagnosis of PTSD because this requires not only the presence of these symptoms but also the presence of clinically significant distress or impairment: the F criterion of DSM-IV-TR. The authors give no evidence that this was the case. In fact all the men had held steady jobs.
Several retrospective studies have shown high incidences of PTSD in combat veterans. The incidences are routinely revised downward when the requirement of presence of ‘significant impairment’ is imposed.
Also, the severity and prevalence seem to grow with time. People who seemed minimally affected at the time of the traumatic event may become more distressed as their environment becomes more favourable or changes its expectations about how people should feel, think or react about things.
The issue is an important one. The concept of PTSD is still subject to controversy. If the symptoms are understood as the normal response expected from a healthy person who is exposed to terrifying and severe experiences, then we should explain why it is that some people seem immune to it and why different people seem to react in different ways to the same stressor.
In contrast, if it constitutes a pathological reaction to stress then the diagnostic emphasis should be steered away from the nature and identity of the stressor, and the emphasis placed instead on the predisposing factors present in the afflicted. It is therefore particularly important for researchers in PTSD to adhere to strict diagnostic guidelines.