COMMENTARY

The Expanding Empire of Posttraumatic Stress Disorder

Richard J. McNally, PhD

Disclosures

April 10, 2006

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Twenty years ago, the American Psychiatric Association recognized posttraumatic stress disorder (PTSD) as a formal psychiatric diagnosis. PTSD was conceptualized as an anxiety disorder that developed following exposure to terrifying, usually life-threatening events -- traumatic stressors lying outside the bounds of everyday experience. Canonical stressors included combat, rape, and confinement to a concentration camp.[1]

But in recent years, we've witnessed a conceptual bracket creep in the definition of trauma whereby ordinary stressors are now deemed capable of producing PTSD.[2] The disorder is now being diagnosed among people whose stressful events range from exposure to crude jokes in the workplace[3] to giving birth to a healthy baby[4] -- and much else in-between. Indeed, one study[5] showed that nearly 90% of Americans qualify as trauma survivors -- as trauma is currently defined.

Why is this a problem? There are 3 reasons.

First, the broadening definition of trauma threatens to undermine any chance we might have of elucidating the psychobiological mechanisms that give rise to PTSD. A survivor of a fender bender is unlikely to have much in common with a survivor of the Holocaust.

Second, the more we broaden the concept of traumatic stressor, the less credibly we can assign causal significance to the stressor itself, and the more we must emphasize preexisting personal vulnerability factors. But shifting the causal burden away from the stressor undercuts the very rationale for having a diagnosis of PTSD in the first place.

Third, by viewing more and more of modern life through the lens of trauma, we may overmedicalize normal emotional responses to stressors and undermine human resilience in the face of adversity.

In conclusion, we should return to the original concept of trauma; the credibility of our field depends on it.

That's my opinion. I'm Dr. Richard J. McNally, Professor of Psychology at Harvard University.


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