The Future of Posttraumatic Stress Disorder in the DSM

Posttraumatic stress disorder (PTSD), added to the DSM nosology in 1980, has become a widely used and studied psychiatric diagnosis—though it has also been the subject of much criticism and controversy. In this paper, we review and discuss a number of issues related to the future of PTSD within the DSM, including the conceptual basis of the disorder, summary of proposed changes to DSM-V, the empirical basis for or against specific disorder criteria, forensic implications, and conclusions and recommendations regarding the future of the disorder in DSM. Overall, the current proposed changes for DSM-V represent a modest improvement over DSM-IV criteria, though they are incremental and relatively minor in nature. As such, they are unlikely to have a meaningful impact on prevalence rates, treatment approaches, or forensic applications of the disorder—and the disorder, as defined, remains problematic in many ways. The empirical data on latent structure of responses to traumatic and general life stressors seem to indicate that perhaps PTSD should be replaced by a dimensional general stress response disorder within the DSM system.