Post-traumatic stress disorder revisited: deconstructing the A-criterion

Since its introduction in 1980, post-traumatic stress disorder (PTSD) has become an indispensable diagnosis in clinical practice and in research. The usefulness and great heuristic value of this newly created diagnosis are undisputed today. In spite of its obvious qualities, there have always been conceptual difficulties with the diagnosis, mainly concerning the crucial A-criterion. The A-criterion of PTSD (i.e. the trauma criterion according to the Diagnostic and Statistical Manual of Mental Disorders) represents the conceptual core of the diagnosis. It is much owed to social and political stances of its original authors and stipulates a monocausal etiology of the disorder. This is in fact inadequate and misleading. Furthermore, the A-criterion is tautologic and therefore dispensable. It may be more appropriate to define PTSD strictly on the basis of descriptive, phenomenological terms and to omit the A-criterion, in order to avoid useless confusions about causal attribution.