Wrong diagnosis

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http://www.timesonline.co.uk/article/0,,8124-1729494,00.html

Wrong diagnosis

By Dr Stuttaford

THERE ARE reports that there is already an increase in the number of

cases among the public of post-traumatic stress disorder in London as

the result of the bombings. Closer scrutiny of the case histories

showed that many of those whose symptoms are recounted are suffering

from acute anxiety, as a result of hearing about the incidents. They

do not have the symptoms of post-traumatic stress disorder, nor have

they had to experience the condition that might have warranted this

diagnosis.

Psychiatric diagnoses tend to become elastic with popular usage. This

can be the result of misuse of a term to preserve a vulnerable ego and

is therefore harmless. But it could have an important influence on

someone’s treatment and be potentially damaging. Another example is in

descriptions of senile dementia. No one likes the term but not all

patients who have dementia have Alzheimer’s disease. When this

description is applied to all old people with a failing memory or

intellect some may be deprived of treatment they should have had, or

be given treatment that they should not have had.

The overuse of the diagnosis of Asperger’s syndrome and autism is

another example. These conditions were originally made with great care

but are now used to cover a range of problems.

Post-traumatic stress disorder is defined as the condition in which

someone repeatedly relives in their mind an horrific event that caused

them intense fear while they were powerless to do anything about it.

People with post-traumatic stress disorder avoid anything that may

rekindle these fears by avoiding similar situations or those that

might trigger thoughts of the incident.

Typically, the precipitating event was one in which the person had

been unable to help themselves, or others. The fearful incident is

usually sufficiently serious to be actually or potentially

life-threatening to the person or those dear to them.

After the disaster the person who has lived through it experiences

flashbacks and nightmares repeatedly. These symptoms are often

compounded by feelings of depression and/or a generalised anxiety

state. They may suffer panic attacks.

Few events are more likely to induce post-traumatic stress disorder

than the fear of death when trapped, powerless, in a rat-infested dark

tunnel, possibly at risk of collapse and in many cases when covered by

debris. The symptoms this could induce are very different from those

of the anxiety that might well be engendered by thoughts of travelling

on the Underground having read of the terrors experienced by strangers.