"I believe that PTSD stands out among psychiatric diagnoses in being particularly resilient to the criticisms commonly levied against such classifications. This is largely due to three factors: (1) it identifies a specific, known cause of the symptoms—the traumatic event, (2) this cause is external to the individual, which reduces the risk of misleading assumptions about an "inner pathology," and (3) it arguably serves as a psychological formulation in miniature, clearly linking symptoms to a causal factor.
What is PTSD?
PTSD is a type of psychiatric diagnosis. It stands for post-traumatic stress disorder. ‘Post’ meaning ‘after’. In other words, it is a disorder of enduring stress after a traumatic event.
Common Criticisms of Psychiatric Diagnoses
Psychiatric diagnoses have been criticised as misleading to the layperson as they can create “the false impression that there is a known inner pathology”. We know a substantial amount about the causes of psychiatric disorders across various levels of analysis including the genetic, cellular, psychological, social and economic. However, each factor on its own tends to have such a slight effect as to only enable differentiation of someone with or without the observable psychiatric symptoms when grouped together in the hundreds or thousands (Marek et al., 2022, Pantelis et al., 2014). Therefore, when an individual receives a psychiatric diagnosis, it is generally unknown what caused the diagnosis for that individual. Instead, they are diagnosed purely by syndrome (from syndromos meaning “a place where several roads meet”) i.e. whether the person presents with a group of certain symptoms at one time.
This is substantially different from receiving for example a diagnosis of COVID, where there is a known single cause (the COVID virus present in the body). Moreover, many of the hypothesised causes of psychiatric diagnoses are external to the individual and a diagnosis may lead people to overlook these in favour of an “inner pathology”. For example, if someone prescribes (excuse the pun) to the serotonin dysfunction theory of depression one may overlook the importance of one’s relationships in maintaining low mood.
An Alternative to Diagnosis?
Psychological formulation, ‘a provisional explanation or hypothesis of how an individual comes to present with a certain disorder or circumstance at a particular point in time’ (Weerasekera, 1996), has been has been proposed as an alternative to psychiatric diagnoses to overcome the above criticisms (Johnstone, 2017).
The National Institute for Health and Care Excellence (NICE) writes that, “psychological formulations provide an explanation of why a problem has occurred and what is maintaining it; they also guide the intervention and predict potential difficulties that might arise. The significant factors within the formulation will be underpinned by the theoretical persuasion of the practitioner, including cognitive behavioural, systemic or psychodynamic. A formulation is a hypothesis, based on the information that is available at the time and will often be developed or change during the course of the intervention.” In other words, a psychological formulation aims to explain in a individualised way why a person is experiencing the problem (e.g. persistent low mood, panic attacks etc.) and also what is keeping it going. This can then be used as a map to guide treatment moving forwards.
How PTSD Is Resilient to These Criticisms
Without getting into the weeds around these criticisms of psychiatric diagnoses in general (see here for a counter view), I believe that PTSD stands out among psychiatric diagnoses in being particularly resilient to the criticisms commonly levied against such classifications. This is largely due to three factors: (1) it identifies a specific, known cause of the symptoms—the traumatic event, (2) this cause is external to the individual, which reduces the risk of misleading assumptions about an "inner pathology," and (3) it arguably serves as a psychological formulation in miniature, clearly linking symptoms to a causal factor. Essentially, the PTSD diagnosis encapsulates the idea that "you are experiencing these symptoms because you have experienced this traumatic event" making it, arguably, a straightforward and ultra-brief psychological formulation.
Beyond Diagnosis
However, it's important to recognize that further psychological formulation would enable a rich and personalised model of what precipitated and currently maintains an individual's PTSD symptoms. This can be invaluable in helping guide treatment and bring about recovery, for instance, by interrupting the maintenance factors of PTSD. Such psychological formulation forms a core part of evidence-based talking therapies for PTSD such as trauma-focussed cognitive-behavioural therapy.