The DOI matches its Crossref record; 67 of the 67 references it cites were found in a registry or an index.
636,120 Ways to Have Posttraumatic Stress Disorder
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369
Diagnostic and Statistical Manual of Mental Disorders
&NA; (1988) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-198802020-00022 · Cited by 12,603
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09091379 · Cited by 7,067
Spitzer, R. L. (1978) · Archives of General Psychiatry · doi:10.1001/archpsyc.1978.01770300115013 · Cited by 6,946
Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.5.748 · Cited by 5,243
On the practice of dichotomization of quantitative variables.
MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002) · Psychological Methods · doi:10.1037/1082-989x.7.1.19 · Cited by 3,538
Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003) · Psychological Bulletin · doi:10.1037/0033-2909.129.1.52 · Cited by 3,322
Differential contribution of amygdala and hippocampus to cued and contextual fear conditioning.
Phillips, R. G., & LeDoux, J. E. (1992) · Behavioral Neuroscience · doi:10.1037/0735-7044.106.2.274 · Cited by 3,292
Muthén, B., & Muthén, L. K. (2000) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2000.tb02070.x · Cited by 3,161
Diagnostic and Statistical Manual of Mental Disorders
Raber, G., & Spokas, M. (2024) · doi:10.4135/9781071886229.n145 · Cited by 2,806
Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults
Breslau, N. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810270028003 · Cited by 2,544
A Multidimensional Meta-Analysis of Psychotherapy for PTSD
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.2.214 · Cited by 1,938
(1990) · Choice Reviews Online · doi:10.5860/choice.27-6366 · Cited by 1,627
Rethinking the Emotional Brain
LeDoux, J. (2012) · Neuron · doi:10.1016/j.neuron.2012.02.004 · Cited by 1,594 · cited 1×
“…life events (Bolger, 1990); how significant others aid in coping with life-threatening events, such as cancer onset (Bolger, Foster, Vinokur, & Ng, 1996); or how contextual threat cues are encoded into memory, leading to behavior change, in animal models (LeDoux, 2012; Phillips & LeDoux, 1992).”
BackgroundCohen, J. (1983) · Applied Psychological Measurement · doi:10.1177/014662168300700301 · Cited by 1,564 · cited 2×
“However, dichotomizing variables has long been discouraged by methodologists because of evidence that the practice weakens statistical power, increases measurement error, and can lead to falsely significant results (Cohen, 1983), while also artificially separating individuals into two groups when these groups are not…”
BackgroundLatent Variable Analysis: Growth Mixture Modeling and Related Techniques for Longitudinal Data
Muthén, B. (2004) · Sage eBooks · doi:10.4135/9781412986311.n19 · Cited by 1,541
Post-Traumatic Stress Disorder in the General Population
Helzer, J. E., Robins, L. N., & McEvoy, L. (1987) · New England Journal of Medicine · doi:10.1056/nejm198712243172604 · Cited by 1,199
Full and partial posttraumatic stress disorder: findings from a community survey
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.8.1114 · Cited by 1,013
Parenthood and Marital Satisfaction: A Meta‐Analytic Review
Twenge, J. M., Campbell, W. K., & Foster, C. A. (2003) · Journal of Marriage and the Family · doi:10.1111/j.1741-3737.2003.00574.x · Cited by 934
Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.021402 · Cited by 900
A meta-analysis of structural brain abnormalities in PTSD
KARL, A., SCHAEFER, M., MALTA, L., DORFEL, D., ROHLEDER, N., & WERNER, A. (2006) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2006.03.004 · Cited by 881
King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998) · Psychological Assessment · doi:10.1037/1040-3590.10.2.90 · Cited by 784
Coping as a personality process: A prospective study.
Bolger, N. P. (1990) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.59.3.525 · Cited by 741
Psychological Resilience After Disaster
Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2006) · Psychological Science · doi:10.1111/j.1467-9280.2006.01682.x · Cited by 715
Simms, L. J., Watson, D., & Doebbeling, B. N. (2002) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.111.4.637 · Cited by 699
DSM-III and the transformation of American psychiatry: a history
Wilson, M. R. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.3.399 · Cited by 635
On Formally Undecidable Propositions of Principia Mathematica and Related Systems
Gödel, K., Meltzer, B., & Schlegel, R. (1964) · Physics Today · doi:10.1063/1.3051400 · Cited by 586
Comorbidity, Impairment, and Suicidality in Subthreshold PTSD
Marshall, R. D., Olfson, M., Hellman, F., Blanco, C., Guardino, M., & Struening, E. L. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.9.1467 · Cited by 578
Simms, L. J., Watson, D., & Doebbelling, B. N. (2002) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.111.4.637 · Cited by 528
A conceptual and empirical examination of justifications for dichotomization.
DeCoster, J., Iselin, A.-M. R., & Gallucci, M. (2009) · Psychological Methods · doi:10.1037/a0016956 · Cited by 513
Bonanno, G. A., Mancini, A. D., Horton, J. L., Powell, T. M., LeardMann, C. A., Boyko, E. J., Wells, T. S., Hooper, T. I., Gackstetter, G. D., Smith, T. C., et al. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.096552 · Cited by 411
Posttraumatic stress following childbirth: A review
Olde, E., van der Hart, O., Kleber, R. J., & van Son, M. J. M. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.07.002 · Cited by 407
Clinical criteria for psychiatric diagnosis and DSM-III
Spitzer, R. L., Endicott, J., & Robins, E. (1975) · American Journal of Psychiatry · doi:10.1176/ajp.132.11.1187 · Cited by 402
Trajectories of resilience, depression, and anxiety following spinal cord injury.
Bonanno, G. A., Kennedy, P., Galatzer-Levy, I. R., Lude, P., & Elfström, M. L. (2012) · Rehabilitation Psychology · doi:10.1037/a0029256 · Cited by 387
Self-citationPsychopathology and resilience following traumatic injury: A latent growth mixture model analysis.
deRoon‐Cassini, T. A., Mancini, A. D., Rusch, M. D., & Bonanno, G. A. (2010) · Rehabilitation Psychology · doi:10.1037/a0018601 · Cited by 379
Close relationships and adjustments to a life crisis: The case of breast cancer.
Bolger, N. P., Foster, M., Vinokur, A. D., & Ng, R. (1996) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.70.2.283 · Cited by 334
Asmundson, G., Frombach, I. K., McQuaid, J. R., Pedrelli, P., Lenox, R., & Stein, M. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00061-3 · Cited by 298
Galatzer‐Levy, I. R., Burton, C. L., & Bonanno, G. A. (2012) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2012.31.6.542 · Cited by 287
Self-citationThe Aetiology of Post-traumatic Stress Disorders Following a Natural Disaster
McFARLANE, A. C. (1988) · The British Journal of Psychiatry · doi:10.1192/bjp.152.1.116 · Cited by 276
Health Status of Vietnam Veterans
(1988) · JAMA · doi:10.1001/jama.259.18.2701 · Cited by 271
ON FORMALLY UNDECIDABLE PROPOSITIONS OF PRINCIPIA MATHEMATICA AND RELATED SYSTEMS
GOODSTEIN, R. L. (1963) · Philosophical Books · doi:10.1111/j.1468-0149.1963.tb00774.x · Cited by 259
A Latent Class Analysis of Dissociation and Posttraumatic Stress Disorder
Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D. T., & Freund, R. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.1574 · Cited by 253
Close relationships and adjustments to a life crisis: The case of breast cancer.
Bolger, N. P., Foster, M., Vinokur, A. D., et al. (1996) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.70.2.283 · Cited by 240
Berntsen (2012) · doi:10.1177/0956797612457389 · Cited by 231
The structure of posttraumatic stress symptoms.
Taylor, S. J., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.107.1.154 · Cited by 217
The structure of posttraumatic stress symptoms.
Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.107.1.154 · Cited by 217
Galatzer‐Levy, I. R., & Bonanno, G. A. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.02.022 · Cited by 216
Self-citationThe Structure of Posttraumatic Stress Disorder
Breslau, N., Reboussin, B. A., Anthony, J. C., & Storr, C. L. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.12.1343 · Cited by 216
Effects of psychotherapeutic treatments for PTSD: A meta‐analysis of controlled clinical trials
Sherman, J. J. (1998) · Journal of Traumatic Stress · doi:10.1023/a:1024444410595 · Cited by 214
DSM categories and dimensions in clinical and research contexts
KRAEMER, H. C. (2007) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.211 · Cited by 195
Post-traumatic Stress Disorder: the History of a Recent Concept
Gersons, B. P. R., & Carlier, I. V. E. (1992) · The British Journal of Psychiatry · doi:10.1192/bjp.161.6.742 · Cited by 149
McNally, R. J. (2009) · Depression and Anxiety · doi:10.1002/da.20586 · Cited by 148
Posttraumatic stress disorder and the structure of common mental disorders
Cox, B. J., Clara, I. P., & Enns, M. W. (2002) · Depression and Anxiety · doi:10.1002/da.10052 · Cited by 147
Galatzer‐Levy, I. R., Brown, A. D., Henn‐Haase, C., Metzler, T. J., Neylan, T. C., & Marmar, C. R. (2013) · Emotion · doi:10.1037/a0031314 · Cited by 138
Self-citationConfirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women
Palmieri, P. A., & Fitzgerald, L. F. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20074 · Cited by 132
A confirmatory factor analysis of posttraumatic stress symptoms
Buckley, T. C., Blanchard, E. B., & Hickling, E. J. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00076-x · Cited by 130
The historical evolution of PTSD diagnostic criteria: From Freud to DSM‐IV
Wilson, J. P. (1994) · Journal of Traumatic Stress · doi:10.1007/bf02103015 · Cited by 116
Galatzer‐Levy, I. R., Madan, A., Neylan, T. C., Henn‐Haase, C., & Marmar, C. R. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20684 · Cited by 105
Self-citationLatent Classes of PTSD Symptoms in Vietnam Veterans
Steenkamp, M. M., Nickerson, A., Maguen, S., Dickstein, B. D., Nash, W. P., & Litz, B. T. (2012) · Behavior Modification · doi:10.1177/0145445512450908 · Cited by 80
Anxiety and post-traumatic stress symptoms following wisdom tooth removal
de Jongh, A., Olff, M., van Hoolwerff, H., Aartman, I. H. A., Broekman, B. F. P., Lindauer, R., & Boer, F. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.09.004 · Cited by 77
Galatzer‐Levy, I. R., Bonanno, G. A., & Mancini, A. D. (2010) · Journal of Neuroscience Psychology and Economics · doi:10.1037/a0020077 · Cited by 68
Self-citationGalatzer‐Levy, I. R., & Bonanno, G. A. (2012) · Journal of Personality · doi:10.1111/jopy.12010 · Cited by 59
Self-citationGalatzer‐Levy, I. R., Mazursky, H., Mancini, A. D., & Bonanno, G. A. (2011) · Journal of Family Psychology · doi:10.1037/a0023759 · Cited by 54
Self-citationThe latent structure of posttraumatic stress disorder: Different models or different populations?
Shevlin, M. E., & Elklit, A. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0028591 · Cited by 36
The Revolution in Psychiatric Diagnosis: Problems at the Foundations
Galatzer‐Levy, I. R., & Galatzer‐Levy, R. M. (2007) · Perspectives in biology and medicine · doi:10.1353/pbm.2007.0016 · Cited by 36
Self-citationLees‐Haley, P. R., Price, J. R., Williams, C. W., & Betz, B. P. (2001) · Journal of Forensic Neuropsychology · doi:10.1300/j151v02n02_04 · Cited by 31
Dimensional analysis of the impact of event scale using structural equation modeling
Larsson, G. (2000) · Journal of Traumatic Stress · doi:10.1023/a:1007798326052 · Cited by 29
Research works printed but not linked: 5
- American Psychiatric Association, 1980, Diagnostic and statistical manual of mental disorders
- 10.1037/0022-3514.59.3.525 · DOI
- 10.1001/jama.1988.03720180027028 · DOI
- Mancini A. D., 2009, Stepping off the hedonic treadmill: Latent class analyses of individual differences in response to major life events
- 10.1002/jts.2490070413 · DOI
Cited by
Sorted by citations
Moving Forward: Challenges and Directions for Psychopathological Network Theory and Methodology
Fried, E. I., & Cramer, A. O. J. (2017) · Perspectives on Psychological Science · doi:10.1177/1745691617705892 · Cited by 1,015
Transdiagnostic approaches to mental health problems: Current status and future directions.
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000482 · Cited by 883
Galatzer-Levy, I. R., Huang, S. H., & Bonanno, G. A. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.05.008 · Cited by 878
Self-citationClark, L. A., Cuthbert, B., Lewis-Fernández, R., Narrow, W. E., & Reed, G. M. (2017) · Psychological Science in the Public Interest · doi:10.1177/1529100617727266 · Cited by 688
A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., Humayun, A., Jones, L. M., Kagee, A., Rousseau, C., et al. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.001 · Cited by 678
Self-citation
Metadata
- 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
- 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
- FWCI
- 32.97
- Type
- journal article
- Language
- en
- Open access
- closed
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review