Guidelines for Differential Diagnoses in a Population With Posttraumatic Stress Disorder

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations.