A2 diagnostic criterion for combat-related posttraumatic stress disorder

Area of Science:

• Psychology
• Military Medicine
• Trauma Studies

Background:

• Posttraumatic stress disorder (PTSD) diagnosis relies on specific criteria, including the A2 response (fear, helplessness, or horror).
• Individuals in high-risk occupations, such as soldiers, may exhibit different responses to trauma due to their training.
• This can lead to underdiagnosis of PTSD in these populations.

Purpose of the Study:

• To investigate whether soldiers trained for high-risk occupations experience PTSD differently.
• To examine the association between alternative A2 responses and PTSD symptom severity.
• To assess the adequacy of current PTSD diagnostic criteria for military personnel.

Main Methods:

• Interviews were conducted with 202 soldiers after a year-long deployment in Iraq.
• Participants' responses to a potentially traumatic event were assessed, focusing on the A2 criterion.
• PTSD Checklist scores were used to measure symptom severity and diagnostic thresholds.

Main Results:

• Reporting an A2 response was linked to higher PTSD Checklist scores.
• No significant differences were found in the percentage of soldiers meeting PTSD diagnostic criteria, regardless of A2 response.
• Common alternative A2 responses included anger and reactions related to military training.

Conclusions:

• The current A2 criterion for PTSD may be too narrow for individuals in high-risk occupations.
• Expanding the A2 criterion could improve the identification of soldiers who require PTSD treatment.
• Diagnostic criteria should be reconsidered to better capture trauma-related distress in trained populations.