PTSD Diagnosis

The article on page 1 of the July 21 issue capably presented the Institute of Medicine's (IOM) support for the use of the DSM-IV PTSD diagnosis by the Department of Veterans Affairs (VA).

As someone who has treated veterans with PTSD for more than a decade, I think your readers migh want to be reminded that many scientists question the validity of this diagnosis for the following reasons: (1) PTSD has no significant biomarkers, according to the IOM—a fact that is ignored by the VA's Dr. Matthew Friedman of the PTSD National Research Center, who on page 18 of the same issue claims that in PTSD “the swtich is stuck on `on,'” raising levels of almost every known neurotransmitter; (2) the diagnosis depends on patients' subjective reports and can be more influenced by the possibility of financial compensation than based on objective findings; (3) symptoms of the syndrome vary widely according to national culture and historical era; (4) quantification and verification of war-trauma events are challenging; (5) it is difficult to separate PTSD from addictive and depressive disorders, that is, PTSD has up to 88 percent comorbidity with other major mental disorders; (6) it is almost impossible to distinguish a normative response to terrible trauma from a pathological disease.