PTSD: Injury or Disorder?

Written by Vicki Lane

I have always been bothered by the term Post-Traumatic Stress Disorder. I do not understand how the reactions that some service members and veterans have to the trauma, terror, sadness, horror, and immoralities of war could be defined and diagnosed as a "disorder." After all, isn’t a disorder when something occurs outside the normal range of what is expected? Doesn’t it imply something is “wrong” with the individual? Since research indicates 20-30% of service members are developing post-traumatic stress symptoms, is it really a disorder, or simply a common reaction to the horrendous stresses of combat?

I understand the need to have a name, defined criteria, and diagnosis for the reactions and symptoms. I understand we need to ensure our service members and veterans are receiving appropriate treatment and qualify for benefits. And I understand this requires a diagnosis. But I don’t believe the diagnosis needs to be a “disorder.”

At our recent Staff Development Conference I had an Aha moment. Dr. Bill Nash, M.D., CAPT, MC, USN (Ret.) was pointing out that perhaps some of what is currently being diagnosed as PTSD is more likely to be Moral Injury (which I addressed in an earlier blog). And although Moral Injury is not yet recognized as a diagnosable injury, other injuries such as Traumatic Brain Injury (TBI) certainly are. So I thought why can’t we change PTSD to PTSI--Post Traumatic Stress Injury?

Well, it turns out Gen. Peter Chiarelli, retired Vice Chief of Staff of the U.S. Army, Dr. Nash, and countless others have been advocating for this very change for several years. Gen. Chiarelli began fighting to change the diagnosis around 2011, following two tours in Iraq, where he became increasingly concerned about the rising rates of suicide in the Army. He concluded after reviewing case after case that many service members hate being diagnosed with a “disorder” and therefore, much too often, suffer in silence and do not receive the help they need and deserve. Gen. Chiarelli believes that the word ‘injury’ suggests that service members and veterans can heal if they receive treatment, however being labeled with a disorder implies that something is permanently wrong and cannot be healed, which may discourage seeking treatment (Ochberg, March-April 2013 Military Review).

Gen. Chiarelli is quoted as saying, “For a soldier who sees the kinds of things soldiers see and experience on the battlefield today, to tell them what they’re experiencing is a disorder does a tremendous disservice. It’s not a disorder. It’s an injury.” Gen. Chiarelli suggests that changing the wording from "disorder" to "injury" would put PTSD on par with other wounds of war. Dr. Nash wrote in an email to the NewsHour, “In war, injuries are inherently honorable. Diseases and disorders are not” (Sagalyn December 6, 2011 PBS Newhour).

Unfortunately, although many military leaders, mental health professionals, and others still believe PTSI is a better term than PTSD because it is more accurate and those who are dealing with the condition prefer it, the publication of the latest edition of the APA Diagnostic and Statistical Manual (the reference manual mental health professionals and physicians use to diagnose mental illness) in May of 2013 still identifies the group of symptoms as Post Traumatic Stress Disorder. And although I came to my Aha moment much later than the likes of Gen. Chiarelli and Dr. Nash, I still firmly believe the service members and veterans I work with who have been diagnosed with PTSD have incurred an injury and are not suffering from a disorder.

Marines in southern Afghanistan. Photo by Patrick Baz/AFP/Getty Images.