Difficulties in Diagnosing PTSD

Medical Reviewer

Post-traumatic stress disorder (PTSD) is one of the better known but perhaps poorly understand disorders. Many people think PTSD is a potential consequence of war and this is probably because battle veterans were the first to bring it to our attention. Today, our understanding of PTSD has  advanced to  the point where we  acknowledge that any traumatic or tragic event can lead to symptoms of PTSD.

PTSD is easy enough to describe but not so simple to diagnose. The process begins by the person being a witness to, or victim of, one or more emotionally traumatic events. It can occur at any age. Such events may include vehicle accidents, kidnappings, natural disasters, muggings, sexual assaults, explosions and so on.

The effect on the individual is profound but symptoms don't necessarily surface immediately. Recollections of the event often tend to come and go. Frightening thoughts and memories may be triggered by an image, a smell, a sound or spontaneously. Nightmares may be so terrible that the person finds difficulty getting to sleep only to then find sleep is disruptive. Flashbacks can overwhelm the individual for seconds, hours or possibly days.

Such a profile suggests the diagnosis of PTSD should be relatively straight forward. In some cases the pattern of events is so well documented that diagnosis is easier, but in cases where exposure to trauma has been long-standing, a variety of other symptoms may mask the cause. Major depression and substance misuse are commonly seen in people with PTSD. Other anxiety-related disorders such as agoraphobia, social phobia, panic disorder and obsessive-compulsive disorder may also be present.

Childhood abuse is one example of long-standing trauma. The self-esteem of the person is often low. They may be sullen, moody and suspicious of the motives of others. They may also have difficulties in forming or maintaining relationships. These however are not symptoms exclusive to PTSD and could just as easily fit some of the diagnostic criteria for borderline personality disorder.

Physical complaints, referred to as somatization disorder, is another common feature of PTSD. Typically the person reports problems with their digestive system, bowels, nerves, reproductive problems, or chronic pain. Symptoms may be reported in isolation or combination. However, even after thorough assessment no physical cause can be found for the symptoms.

Very often, the family doctor is presented with a person who complains of physical rather than psychological symptoms. Unless the doctor is sensitive to the possibility of PSTD the danger is one of overlooking the possibility in favor of treating the most obvious symptoms. If PSTD is suspected, the doctor may consider referring the patient for psychotherapy. A diagnosis of PTSD will not be considered unless a clear history emerges of a traumatic event.


American Psychiatric Association (1994) DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. 4th Revised Edition.

Cohen, H (2006) Symptoms & Diagnosis of PTSD. PsychCentral.com http://psychcentral.com/lib/2006/symptoms-and-diagnosis-of-ptsd/