Review article
Rationale for a posttraumatic stress spectrum disorder

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Symptom severity

Using DSM-III criteria, the National Comorbidity Survey found a lifetime prevalence of PTSD of 7.8%. This survey also recognized the impact of several noncombat forms of trauma, including rape and molestation in women and witnessing someone being badly injured or killed [10]. Using similar criteria to identify patients with PTSD, numerous studies have demonstrated substantial biopsychosocial impairment for occupation [11], somatic distress and concomitant medical illness [12], poor quality of

Stressor criteria

An important evolution in the diagnostic criteria for PTSD concerns the inclusion of the victim's appraisal of the event. Before DSM-III, many clinicians limited the diagnosis to individuals exposed to combat or only the severest forms of civilian trauma. In DSM-III and DSM-III-R, the event was required to be objectively catastrophic and out of keeping with ordinary events of life. Automobile accidents or death of a loved one did not qualify. Although discussed in the text of DSM-III-R, the

Trauma-related conditions

Stressful events are known to precipitate and exacerbate various psychiatric conditions. In the ICD-10 classification [32], acute and chronic PTSD, adjustment disorders, and personality change after catastrophic stress are included in a stress and trauma section. Similarly, the DSM-IV Advisory Subcommittee unanimously voted to classify PTSD in a new stress response category [33]. One proposal for classification might include PTSD at the severe end of a spectrum of stress-related disorders, with

Summary

An understanding of PTSD and stress-related conditions is in its infancy. This is not surprising given the fact PTSD was not recognized as a distinct diagnostic entity until 1980. Since that time, the diagnostic classification has undergone continuous change as our understanding of PTSD is refined. The authors believe that PTSD can be best understood through a dimensional conceptualization viewed along at least three spectra: (1) symptom severity, (2) the nature of the stressor, and (3)

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