Clinical detection, diagnosis, and differential diagnosis of post-traumatic stress disorder

This article has reviewed the detection, diagnosis, and differential diagnosis of PTSD. Recognition of particular effects of traumatic stress on patients' communications and adjustments in interviewing technique facilitate the expression and detection of PTSD when it is present. The phenomenologic boundaries between PTSD and a number of clinical syndromes and disorders are explored in detail. Delineation of PTSD from other disorders even when they co-occur with PTSD is almost always possible with effective rapport and knowledge from clinical research. An understanding of the role of traumatic stress in the origin of several disorders aside from PTSD assists in differential diagnosis, particularly when PTSD is present along with another trauma disorder. To avoid an undue, misleading proliferation of diagnoses (illusory comorbidity), the clinician should move beyond simply a cross-sectional enumeration of symptoms, to conduct a careful exploration of the patient's longitudinal history and thus understand fully which features are secondary to traumatic stress.