Conceptualization of Stress-Related Disorders and PTSD by Cognitive Behavior Therapists

Background: Many people experience stressful life events like social conflicts, accidents, or physical violence. Some develop post-traumatic stress disorders (PTSD) thereafter. A diagnostic problem is the differentiation between causal stressful events, occasional causes, pseudo-causes or retrospective reinterpretations. This study investigates how often the diagnosis PTSD is mentioned in outpatient behavioral therapy patients, and which causes, findings, and therapeutic measures are reported. Patients and Method: In 1,480 behavioral therapy case reports the assignment of the diagnosis PTSD was explored. Cases with PTSD (N = 106) were compared with other cases without PTSD (N = 95). Results: In 7.16% the diagnosis PTSD was given. In both groups 90% reported earlier stressful experiences. In only 17% of the PTSD cases an “extraordinary threat of catastrophic proportions” was reported. In a quarter, the trauma assumption was based only on therapist or patient suggestions. Dissociative symptoms or intrusion were described only in the PTSD cases. Discussion: The data suggest that (a) almost all patients report stressful experiences, (b) the diagnosis of PTSD is given only in a limited number of patients, (c) in PTSD cases, intrusion and dissociation are reported only in a minority of cases, and (d) in PTSD cases, the full spectrum of exposure techniques is mentioned. Conclusion: Stress-associated disorders need precise description and differentiation.