Staff Voices - Posttraumatic Stress - Is It a Disorder or Injury?

On Sunday, May 6, 2012, Greg Jaffe wrote an article in the Washington Post titled, Psychiatrists Seek New Name, and Less Stigma, for PTSD: Proposal Would Define PTSD as an Injury. This article sketches the current debate about whether the name posttraumatic stress disorder (PTSD) should be changed to posttraumatic stress injury—a change in which the word “disorder” would be replaced by “injury”. Infused partly by Army leadership, this call for change has stirred various questions including whether the name change would really reduce stigma and how it would impact the legitimacy of the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders and in health insurance and federal disability claims.

Several arguments for switching the name to posttraumatic injury are advanced in the article, including these:

• It would reduce stigma because “injury” is more palatable and acceptable to service members than “disorder,” so more military personnel would seek help.
• “Injury” suggests that a person can improve with treatment, there is hope and a path of recovery, however, “disorder” implies a permanent, life-long condition that won’t improve.
• PTSD is the only mental health diagnosis that requires identification of an outside traumatic force from which symptoms evolve. This requirement implies that a mechanism of “injury” is at play.
• There is a life-altering experience that changes the physiology of the brain and way the memory system works in an individual who is traumatized, suggesting that an injury has occurred.
• The name change would make it easier to revise the Purple Heart award criteria. A neurobiological and psychological injury sustained from a traumatic event while serving honorably would finally be commensurate to a physical wound sustained while serving with valor.

Opponents of the name change submit the following points of view:

• The term “injury” suggests a discrete period of suffering, while in some cases of PTSD, the effects from the traumatic exposure persist long beyond a distinct period of time, i.e., the damage is chronic.
• Not everyone who is exposed to a traumatic event responds similarly by developing PTSD – risk and protective variables impact how a person responds. Yet for an injury like a gunshot wound, most people would be equally vulnerable to its effects. The word “disorder” (not “injury”) more appropriately reflects that some people are greater risk for developing PTSD than others.
• A name change could make it more difficult for service members to receive permanent-disability payments for their mental health condition.
• Putting lots of hope into a name change misses the boat. It camouflages the larger, more difficult issues surrounding PTSD that the military actually needs to address. For example, that multiple deployments to a combat zone have damaging effects on service members no matter what the condition is called.

The arguments on both sides are strong, making it difficult to come to a consensus. PTSD continues to be a divisive topic worthy of this kind of debate.