What's In a Name? - Name Change Proponents Say Labeling PTSD a 'Disorder' Prevents Treatment

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What's In a Name? - Name Change Proponents Say Labeling PTSD a 'Disorder' Prevents Treatment

Categorized in: Department of Defense (DoD), Department of Veterans Affairs (VA), June 2012, PTSD

There is no “magic bullet” to solving stigma, but the military is trying various approaches, he said.
“We are looking at a multimodality approach,” Wynn said. “There is the embedded healthcare provider approach where the military is looking at putting mental-health providers out into clinics in primary care and moving them out of the hospitals.”
His presentation also suggested that, of those who begin PTSD treatment, between 20% and 50% walk away before its completion. Having a menu of options of evidence-based treatments may help patients stick with their care and bring those in who are not receiving care.
“Research takes time,” Wynn said. “I am optimistic with the continued
efforts of those in the mental-health community, the military leadership and Congress and others that we will overcome at least a portion of the stigma and barriers problem and be able to give people an array of options, including ones that allow them not to directly engage with mental health (i.e., virtual reality,
Internet-based cognitive behavioral therapies, recreational therapies) that we will be able to engage at least a significant chunk of the folks who are not presenting
for care out of some misperception regarding stigma.”
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J, Warner CM, Hoge C. Importance of anonymity to encourage honest
reporting in mental health screening after combat deployment. Arch Gen
Psychiatry. 2011 Oct;68(10):1065-71. PubMed PMID: 21969463.

Friedman, who made his case for keeping the name PTSD at the APA forum attended by Chiarelli, said that a disorder, whether it be PTSD or depression “reflects a disturbance in the biological as well as the psychological and development processes underlying mental function.

“We know from abundant research that PTSD is clearly associated with biological alterations, especially in brain function. So is depression. According to this logic, we should call depression suffered in the war zone a major depressive injury to split it off from all other depressive episodes,” Friedman said. “So to change PTSD to PTSI without changing anything else would, in my opinion, accomplish nothing positive. And, on the negative side, it would confuse the issue and set up diagnostic distinctions for which there is no scientific evidence,” he said.

He suggested that a useful model could be the way the situation is handled in Canada. While the military uses the term “operational stress injury,” the medical diagnosis has remained PTSD.

“These changes are proof that stigma can be addressed successfully without changing the diagnostic label. So, we can have it both ways, keep the PTSD diagnostic term and have it regarded as an injury,” Friedman said at the forum.

Canadian soldiers with PTSD also are eligible for the Sacrifice Medal, he pointed out, but “unfortunately, the DoD decided not to give a Purple Heart for PTSD.

“I realize it is a complicated, contentious issue but I think it would have gone much further in reducing stigma than changing the name of PTSD to PTSI.”

The next DSM is set to be published in May 2013, with public comment accepted for the revisions until June 15, 2012.

Those who support the name change said they will continue their campaign. Ochberg and Shay created a website http://www.posttraumaticstressinjury.org/ that includes endorsements from individuals and organizations that support a name change.

Ochberg said that getting rid of “disorder” in PTSD also is a matter of honor.

“I believe the science already supports injury, [but] if you want to argue it is a draw and that the validity of injury is no more or less valid than the validity of disorder, what about the advantage of the therapist and the patient in doing therapy and what about the advantage to the PTS wounded person in feeling honored and being honored?” Ochberg told U.S. Medicine.

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