Comparing the diagnosis of PTSD when assessing worst versus multiple traumatic events in a chronically mentally ill sample

Authors

  • Tracy L. Simpson,

    Corresponding author
    1. VA Puget Sound Health Care System and University of Washington
    Current affiliation:
    1. VA Puget Sound Health Care System, Mental Health Service, Seattle, WA and School of Medicine, University of Washington
    • VA Puget Sound Health Care System, 1660 S. Columbian Way (116-WTRC), Seattle, WA
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  • Katherine Anne Comtois,

    1. University of Washington
    Current affiliation:
    1. School of Medicine, University of Washington
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  • Sally A. Moore,

    1. VA Puget Sound Health Care System and University of Washington
    Current affiliation:
    1. VA Puget Sound Health Care System, Mental Health Service, Seattle, WA and School of Medicine, University of Washington
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  • Debra Kaysen

    1. University of Washington
    Current affiliation:
    1. School of Medicine, University of Washington
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  • The authors wish to thank the Alcohol and Drug Abuse Institute of the University of Washington for their support of this project through their small grants program. We would also like to thank both the VA Puget Sound Health Care System and Harborview Medical Center for their generous support of the investigators and the Harborview participants for their time and effort. Writing of this manuscript was also partially supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs. Finally, we would like to thank Laura Holdcraft for her contributions to the original conceptualization of this project.

Abstract

Despite interest in the nature of the traumatic event required to meet Criterion A for posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), little attention has been paid to the diagnostic ramifications of linking PTSD symptoms to a single traumatic event in the context of multiple trauma exposures. In this study, 67 dually diagnosed clients with at least 2 potential Criterion A traumatic events completed the Posttraumatic Stress Diagnostic Scale twice, in counterbalanced order: once regarding their worst event and once regarding all events. When responding regarding their worst trauma, 53.7% met probable PTSD criteria. This rose to 67.2% when considering all traumas. Although preliminary, these results suggest that linking PTSD symptoms to a single traumatic event excludes a meaningful number of cases who are otherwise indistinguishable based on symptom profile.

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