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Cited by 778Posttraumatic Stress Disorder ResearchPersonality Disorders and PsychopathologyAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

636,120 Ways to Have Posttraumatic Stress Disorder

Galatzer-Levy, Isaac R., Bryant, Richard A.·2013·Perspectives on Psychological Science
DOI 10.1177/1745691613504115
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Abstract

In an attempt to capture the variety of symptoms that emerge following traumatic stress, the revision of posttraumatic stress disorder (PTSD) criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM–5) has expanded to include additional symptom presentations. One consequence of this expansion is that it increases the amorphous nature of the classification. Using a binomial equation to elucidate possible symptom combinations, we demonstrate that the DSM–IV criteria listed for PTSD have a high level of symptom profile heterogeneity (79,794 combinations); the changes result in an eightfold expansion in the DSM–5, to 636,120 combinations. In this article, we use the example of PTSD to discuss the limitations of DSM-based diagnostic entities for classification in research by elucidating inherent flaws that are either specific artifacts from the history of the DSM or intrinsic to the underlying logic of the DSM’s method of classification. We discuss new directions in research that can provide better information regarding both clinical and nonclinical behavioral heterogeneity in response to potentially traumatic and common stressful life events. These empirical alternatives to an a priori classification system hold promise for answering questions about why diversity occurs in response to stressors.

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  • Variation in results on reward functioning in PTSD may reflect heterogeneity of the causes, symptoms, and underlying reward mechanisms of posttraumatic stress.

    “Variation in results may reflect heterogeneity of the causes, symptoms (120), and underlying reward mechanisms (121) of posttraumatic stress.”

    From A transdiagnostic perspective on social anhedonia (2019) · cites this paper as [120]

  • Patients with the same diagnosis may show different symptom profiles, which may also vary over time.

    “Patients with the same diagnosis may show different symptom profiles [1], which may also vary over time.”

    From Using person-specific networks in psychotherapy: challenges, limitations, and how we could use them anyway (2020) · cites this paper as [1]

  • When using the DSM-5 definition of PTSD, there are 636,120 permutations of how the disorder may present, which may impair the identification of meaningful biomarkers.

    “A further argument is that, when using the DSM-5 definition of PTSD, there are 636,120 permutations of how the disorder may present 169 , which may impair the identification of meaningful biomarkers.”

    From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [169]

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Related

Authors
Galatzer-Levy, I. R., & Bryant, R. A.
Affiliations
  • New York University School of Medicine
  • UNSW Sydney (AU)
ORCID
Bryant, Richard A.
Venue
Perspectives on Psychological Science
Publisher
SAGE Publications
Published
2013-11
Volume
8
Issue
6
Pages
651-662
ISSN
  • 1745-6916 (ISSN-L)
  • 1745-6924
DOI
10.1177/1745691613504115
OpenAlex
W1985730575
Cited by
778
References
64
Citations by year
2026: 47 · 2025: 70 · 2024: 92 · 2023: 78 · 2022: 88 · 2021: 71 · 2020: 79 · 2019: 59 · 2018: 58 · 2017: 46 · 2016: 40 · 2015: 32 · 2014: 16 · 2013: 1 · 2012: 1
FWCI
32.97
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Perspectives on Psychological Science (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
post-traumatic stress disorder, DSM-5, DSM-IV, diagnostic criteria, symptom combinations, psychiatric classification, binomial model, potentially traumatic events

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