Why and how do people with traumatic stress might get mental illness such as PTSD and dissociative disorder? How come that some people without any overt trauma history nonetheless exhibit trauma-related disorder? With these questions in our mind we will discuss the notion of resilience in this chapter.
An intriguing question
Almost ten years ago, a young psychiatrist approached me and asked this question: “One of my patients does not seem to have clear history of trauma, but he has symptoms of PTSD. Can we diagnose him with PTSD officially?”
“I think we can….” I replied, but I was not quite sure about this answer, to be honest. In fact I hesitated about whether I should answer yes or no, and I tossed a coin in my mind before I gave this answer.
It has been quite a while since this episode, but I always remember this question, and each time I have the same hesitation. However, I also recognize, perhaps better than ten years ago, that this question in itself is very tricky and probably there is not single right answer. Whether or not we say “yes” to this question depends partly on how we define PTSD.
First of all, I would like to give a textbook answer to the question of the young psychiatrist. The diagnostic criteria for PTSD by DSM-IV-TR are fairly clear and straightforward. A patient needs to meet all four criteria (criterion A~D) to be diagnosed with PTSD. These are criterion A (trauma history), criterion B (intrusion), criterion C (avoidance/numbing), and criterion D (arousal). The existence of trauma is listed in criteria A which is sometimes called the “stressor criteria”. Unless one experiences serious trauma as defined by DSM-IV-TR, the diagnoses of PTSD should not be made. The same applies to PTSD criteria of ICD-10.
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