Although the American Psychiatric Association voted to retain the word "disorder" in the term "posttraumatic stress disorder" for its Diagnostic and Statistical Manual of Mental Disorders, the term "posttraumatic stress" is being used informally by some within military communities. RAND explored the rationales for not changing the diagnostic terminology, and possible effects of widespread informal use of new terminology.
The Role and Importance of the 'D' in PTSD
- Would changing the term reduce the stigma associated with the condition?
- Would changing the term increase the number of service members seeking treatment for the condition?
- What are the other intended and unintended consequences of this change in terminology?
Recently, the American Psychiatric Association (APA) board of trustees voted on changes to the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Among the decisions was one to retain the word "disorder" in the term "posttraumatic stress disorder." U.S. Army leadership initially requested a change in terminology, stating that the word "disorder" is stigmatizing and that removing it would encourage more individuals suffering from symptoms to access care. Although the APA has issued its ruling, the term "posttraumatic stress" is being used informally by some individuals within military communities. It is unclear whether informal use of the term will continue, or whether military leaders will continue to advocate future changes to the DSM. RAND explored the rationales for not changing the diagnostic terminology, and to the extent possible, anticipated what the effects of widespread informal use of new terminology might be.
The Specific Nature of PTSD-Related Social Stigma, Particularly Among U.S. Military Service Members, Is Not Well Understood
- Few studies demonstrate stigmatization among U.S. military service members with PTSD.
- No studies measure the extent to which PTSD-related social stigma reduces the utilization of treatment.
Changing the Term Is Unlikely to Result in a Significant Increase in Individuals Willing to Be Diagnosed or Treated, and Could Have Deleterious Consequences
- Adopting the term "injury" may have implications beyond its effect on the likelihood of stigma that could, in theory, reduce the utilization of treatment.
- Psychiatric diagnoses are used within institutions such as the U.S. military in ways that may adversely affect how a diagnosed individual is treated — for example, when determining eligibility for security clearances and when determining whether a given service member is fit for deployment — regardless of the diagnostic terminology used.
- Without changing the broader institutional factors that result in discrimination against those with the label, the new name seems unlikely to result in a significant increase in individuals eager to be diagnosed or treated, and could even have the opposite effect.
- Any changes to the post-traumatic stress disorder label should be supported by evidence that reflects the perspectives of the mental health treatment and research communities as well as the perspectives of military service members, veterans, and other traumatized individuals who would be directly affected by the change in terminology.