New PTSD diagnosis changes could tax resources, CF member says

Recent changes in how PTSD is diagnosed, may do more harm than good, Canadian Forces member says.

Canadian Forces member looks at expansion of PTSD diagnosis in newest DSM

Canadian soldiers from Task Force 3-09 Battle Group are seen in silhouette as they patrol at the start of operation Tazi, a village search and securing operation in the Dand area of Kandahar Province, southern Afghanistan in 2010. (Kirsty Wigglesworth/Associated Press)

Post-Traumatic Stress Disorder is a very personal affliction.

It is a normal reaction to an abnormal event, and no two people are affected the same way.

A couple years ago, I was busying myself around the house, completing the normal, mundane chores everyone has to attend to from time to time. During my chores I often tune in to CBC Radio to keep some ambient sound in the background.

One particular day, a program came on during which a soldier suffering PTSD from an incident in Afghanistan shared his story.

I went about my chores half-listening to the radio when suddenly his description of events caught my attention.

I stopped what I was doing and turned up the volume. As his story unfolded I realized that I had been present at the very event he described: a tense standoff with a group of Afghan warriors that could have escalated to violence but was in the end resolved peacefully.

During his narrative the soldier began to cry. He shared with the audience the fear he had endured at the time, the recurring nightmares he had experienced afterwards, the stress this event had put on his marriage and his subsequent difficulties with the military bureaucracy.

What struck me most was that, despite being present at the event, I had not experienced any mental health challenges relating to it, nor have I to this day.

To be sure, this was an extremely tense situation. During a speech to a school group in my hometown, after I returned from Afghanistan, I was asked if I ever felt my life was in danger.

I replied that, during my tour in Afghanistan, there were two specific times I genuinely feared for my life, and this particular event was one of them.

But despite the fear I experienced, I suffered no nightmares, no panic attacks.

I’m not for a moment suggesting that I am built of sterner stuff than my colleague. No two people react to the same event in the same way. Nor am I suggesting my colleague was not genuinely suffering from PTSD. This just serves to demonstrate that PTSD is a difficult disorder to both diagnose and treat.

Recent changes in how PTSD is diagnosed, however, may do more harm than good.

The Diagnostic and Statistical Manual of Mental Disorders is the guide book for psychiatrists and how they treat people with mental health issues.

The latest version of this book, DSM 5, was released in May 2013, and its guidance for the diagnosis of PTSD varies sharply from the previous version, DSM4. 

According to the American Psychiatric Association, the most profound change between the two versions as far is PTSD is concerned, is the criterion for a traumatic event.

DSM 4 requires the traumatic event to have been either personally experienced or witnessed. DSM5, however, has broadened the criteria to include learning that a traumatic event has happened to a family member or close friend.

I certainly do not have the qualifications to compare with the learned members of the APA who have seen fit to broaden the criteria of a traumatic event.

Nevertheless, in my layman’s mind, I do have reservations.

The problem I see is that PTSD may become far too broadly diagnosed.

I am not for a moment advocating that those who require mental help assistance should not receive it. Quite the contrary, my concern is that when something becomes so broadly interpreted, how can we ensure the proper resources go to those who most deserve them?

It is unfortunate to say there will be those who will use this broader definition to acquire undeserved benefits, which will in turn divert those resources from where they really need to go. Fortunately, they are in the minority.

In the military, those abusing the system are readily identified by the rank and file. Soldiers have their own criteria for what qualifies for PTSD.

This, of course, has problems of its own, as peer pressure can discourage those needing help from seeking it.

Fortunately, some excellent leadership in the Canadian Forces and a marked increase in mental health awareness have fostered a broader and more inclusive view of PTSD amongst the Canadian military.

Nonetheless, when troops who need help observe an abuse of the system, it tragically deters them from seeking the help they need, fearing to be considered a malingerer.

There’s no easy answer to the problem of PTSD. Like physical wounds, it is an injury and requires treatment as such, but finite resources spread too thin will, in the long run, hurt more people than they help.

David Grebstad of Etobicoke, Ont., is an amateur historian and serving member of the Canadian Armed Forces. His opinions do not necessarily reflect official Department of National Defence or Canadian Forces policy.


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