PTSD: Constructs, diagnoses, disorders, syndromes, symptoms, and structure

The fifth revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM5) regarding posttraumatic stress disorder (PTSD) has been accompanied by debates applicable to the nomenclature at large as well as those issues specific to reactions to exposure to traumatic stressors. Among the former, a core dispute involves dimensional versus categorical approaches (e.g., Linscott & van Os, 2010). Among the latter are (a) where PTSD and acute stress disorder (ASD) belong in the nomenclature (i.e., remain or not among disorders currently conceptualized as anxiety disorders); (b) should complex PTSD (CPTSD) be added to the list; (c) what changes, if any, should occur in the criteria; (d) what way should they be modified for children, and (e) what is the evidence and conceptual rationale for these modifications. A parallel process is occurring in the 11th revision of the International Classification of Diseases (ICD-11), making the discussion and decisions likely to have scientific and pragmatic worldwide implications. With respect to PTSD, as of this writing, an outcome for a number of these issues for DSM-5 have been proposed (see Friedman et al., 2011), the most far reaching of which is a byproduct of an overall revision of the organizational structure of the chapters and listings in the DSM-5: the creation of traumaand stressor-related disorders. The administrative need for a nomenclature of disorders, diseases, injuries, and treatments is obvious, and the goal of making it easier to use and more reflective of current knowledge is also laudable. Nevertheless, there are conceptual conundrums that the current revisions face and the terms that are used in the manuals have implications regarding the fundamental issues