Some U.S. Soldiers May Not Get Stress Treatment Under New Rules

Aug 13, 2014 7:01 pm ET

Aug. 14 (Bloomberg) -- Some U.S. soldiers suffering from post-traumatic stress disorder after service in Iraq and Afghanistan may not be diagnosed with the condition because of new guidelines to assess the illness, a study found.

About 1 in 3 soldiers found to have PTSD under the previous diagnostic standards were missed by the new criteria, according to today’s research in the journal the Lancet Psychiatry.

About 5.2 million adults in the U.S. suffer from post- traumatic stress disorder each year, according to the U.S. Department of Veterans Affairs. Today’s study, one of the first to compare the two sets of diagnostic standards in infantry soldiers, shows that more research is needed to determine how the new rules will affect patient care, said Charles Hoge, the lead study author and a senior scientist at Walter Reed Army Institute of Research in Silver Spring, Maryland.

“For military service members and veterans if they’ve been treated for PTSD or are in treatment for PTSD according to the old criteria, their diagnosis isn’t going to change,” Hoge said in a telephone interview. “New people coming into treatment now, it is possible some of those individuals would’ve gotten a diagnosis of PTSD but they are not receiving that diagnosis now.”

People who have post-traumatic stress disorder experience flashbacks, nightmares and mood swings that disrupt their daily lives. The disorder is best known for occurring in veterans of war or victims of an assault.

Diagnostic Manual

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, was released in May 2013 to replace older versions. The new criteria moved PTSD to the category of disorders related to trauma and stressors from anxiety disorders; increased the number of PTSD symptoms; and recommended that patients who have symptoms that don’t quite meet the threshold for PTSD be diagnosed with adjustment disorder, or the inability to adapt to stressful situations.

Alexander McFarlane, who wrote an accompanying editorial, said one “critical” difference in the new criteria is in order to be diagnosed with post-traumatic stress disorder a person has to report avoidance behaviors. He said soldiers and emergency workers are taught to override their fear and don’t avoid fear situations even if they find them distressing.

“People who are truly ill will not get pensions or access to treatment,” McFarlane, a professor of psychiatry and director of the Centre for Traumatic Stress Studies at the University of Adelaide in Australia, said in an e-mail. He suggests doctors use the older criteria until the questions raised over the new guidelines are answered.

The Department of Defense and Veterans Affairs are looking at the new criteria and discussing what is the best diagnosis to use for those who fall below the current PTSD threshold, Hoge said.

Study Results

Researchers in the study surveyed 1,822 U.S. soldiers, including 946 who had been deployed to Iraq and Afghanistan. The surveys included questions under the old and new criteria.

They found a similar number of soldiers were positive for post-traumatic stress disorder under each criteria. The study found that about 30 percent who were positive under the older criteria weren’t classified as having PTSD under DSM-5. The research also showed that about 20 percent of soldiers were positive for PTSD only under the 2013 criteria.

Hoge said the new diagnostic guidelines, while similar, aren’t an improvement. In his practice, he said, if a patient meets the definition under the old criteria he still will diagnose them as having post-traumatic stress disorder.