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I am a combat veteran, but I was not diagnosed with PTSD. When I was in the military, there were Soldiers with PTSD who had never served in a combat zone. There were also Soldiers who served in a combat zone but never saw combat. These Soldiers were sometimes diagnosed with PTSD from their tour.

Is PTSD Overdiagnosed for US Military Soldiers? Could Soldiers really be affected by anxiety and other life factors instead?

Claim: http://www.wired.com/2012/03/the-ptsd-trap/

Edward G-Jones
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Engineer2021
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  • What do you mean by "prevalent"? Do you mean if there are cases of fraud? Otherwise I wouldn't be surprised to find that the PTSD occurrence in war veterans is higher than average, so I'm not quite sure what we could consider "that" prevalent. – Sklivvz Jul 20 '14 at 11:18
  • @Sklivvz: Not necessarily fraud (there could be a very small percentage), but rather misdiagnosis - which makes it appear more prevalent – Engineer2021 Jul 20 '14 at 11:20
  • Ok, so is the question you are trying to ask "are soldiers overdiagnosed with PTSD?" – Sklivvz Jul 20 '14 at 11:22
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    A. If this is narrowed down to the US military, it should state it in the body of the question, not just the tags. B. I think this question lucks a noteable claim, all we have is the observation of a single not professional supposed observation – SIMEL Jul 20 '14 at 13:09
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    Your question seems to imply that it is only possible to have PTSD is you have seen combat, which is not the case. – DJClayworth May 21 '15 at 16:26
  • The implications of this question and Awexomecross's answer are... frightening. A brain injury being misdiagnosed as a psychological disorder? The military leading members to think that PTSD is a combat thing? If anything, I'd argue that, given our nation's state in mental health, PTSD is likely underdiagnosed! – Plumbing for Ankit May 21 '15 at 21:04
  • @Axelrod: There are many Soldiers who are diagnosed with PTSD who have never been to combat. My first hand experience has been that is is a catch all for some malingerers. – Engineer2021 May 26 '15 at 00:10
  • @staticx , PTSD has nothing to do with combat. It can be caused by combat, but it's a disorder caused by exposure to traumatic stress. Even people in car crashes can get it. And for what it's worth, disorders really are catch alls; they're diagnosed by the symptoms, not the cause. – Plumbing for Ankit May 26 '15 at 16:58

2 Answers2

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Yes.

"Overdiagnosing" of PTSD can be occur in a few different ways. For example, we (soldiers) get briefings all the time about the distinction between Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).

They share several similar symptoms, however they differ greatly in their method of sustainment and long-term effects. TBI is more physiological damage, sustained commonly from impacts and blasts, which are common in combat operations with the Infantry and Special Operations communities. PTSD, on the other hand is more psychological damage.

Because both can likely be incurred from the same incident, it makes it difficult to distinguish between the two. In recent wars, there was potential for TBI to be misdiagnosed as PTSD.

Using questionnaires, 59% [of respondents with TBI] fulfilled criteria for PTSD on the Posttraumatic Diagnostic Scale and 44% on the Impact of Events Scale, whereas using the structured interview (Clinician Administered PTSD Scale) only 3% were ‘cases’. This discrepancy may arise from confusions between effects of PTSD and traumatic brain injury.

The US military, in response, conducts frequent assessments before and after combat tours to track any developments in the psychological or physiological damage. However, due to inadequate screening, it is difficult to tell the exact number of misdiagnosed cases.

Statistics compiled by the VA show that more than 83,000 Iraq and Afghanistan veterans have sought care for psychological disorders. The department does not track the number of TBI cases [...] The Defense Department also does not have figures on the number of brain injuries, but Pentagon officials estimated that they have found about 2,500 potential cases so far.

"The number of people who have suffered from mild traumatic brain injury could be in the thousands, but we just won't know about it unless we screen everybody who comes back [...] Maybe it's politics, maybe it's negligence, maybe it's incompetence," Rieckhoff said. "I don't know. I just know that it's taking too long to take things like brain injury seriously."

There are also been issues with malingering which also might account for overdiagnosing. Getting diagnosed with PTSD before getting discharged from the military is a sure way to get free medical disability. I have witnessed several first-hand accounts of this, but those aren't acceptable sources for this website. However, these concerns aren't isolated:

As disability awards for PTSD have grown nearly fivefold over the past 13 years, so have concerns that many veterans might be exaggerating or lying to win benefits. Moering, a former Marine, estimates that roughly half of the veterans he evaluates for the disorder exaggerate or fabricate symptoms. [...] Frueh and other critics of the disability system have sparred in medical journals with senior VA mental-health officials, who argue that the extent of malingering is impossible to know without more research.

Community
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    While your answer is interesting and takes steps towards answering the question it doesn't actually answer it, while you give evidence of the occurrence of misdiagnosis you don't give an overall picture of the over-diagnosis in US military. You also, at the beginning of the answer, make the claim 'In short, an answer to your question is yes.' but it's unsupported. – Edward G-Jones May 21 '15 at 09:11
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    @Noodlemanny: Please see some edits I have made. – Oddthinking May 21 '15 at 09:18
  • Right. Good old @Oddthinking – Edward G-Jones May 21 '15 at 09:28
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    Although fleshed out I actually still feel the answer isn't sufficient. It points out misdiagnosis is possible but gives no indication of it's extent. The last quote even states it's "impossible to know without more research", this is in direct conflict with the opening statement. – Edward G-Jones May 21 '15 at 09:47
  • @Noodlemanny, What is this answer lacking? OP asked if soldiers are overdiagnosed with PTSD. The links I provided about TBI being misdiagnosed as PTSD already proves the US military's overdiagnosis of PTSD. If something about that link doesn't support that claim, then I can find more corroborating evidence, because I know this to be a fact, and I want to try to give OP a sufficient answer. –  May 21 '15 at 12:11
  • @Noodlemanny, As far as OP giving examples of PTSD in a non-combat environment (which I don't feel his question was exclusive to this scenario), that would be explained by malingering and more misdiagnosis. Which, the article I posted, though not totally conclusive evidence (not that such evidence could be provided on the subject), should be enough to validate malingering as a concern. And the "impossible to know without more research" isn't in conflict with my statements, because it would pertain to malingering only, and not the evidence provided for TBI misdiagnosis. –  May 21 '15 at 12:16
  • The first reference is of individuals taking a survey and identifying as PTSD but it doesn't actually mention anything about professional/medical diagnosis (not at least from what I gathered) and then the second reference then states sources have said that "the extent of malingering is impossible to know without more research.". **The two sources simply don't provide enough evidence to support a claim**. My main issue is the question asks "Is PTSD Overdiagnosed for US Military Soldiers?", so saying that misdiagnosis is possible, even probable, doesn't answer the question. – Edward G-Jones May 21 '15 at 12:29
  • Wouldn't misdiagnosis count as overdiagnosis? If cases of TBI were mistaken for PTSD, to me, that would count as an overdiagnosis for PTSD. And for the first reference, the survey is one of the methods they used to determine if the TBI patients also fit the 'caseness' for PTSD. The survey is part of what medical professionals use to determine PTSD, having taken such surveys myself, i can vouch for it. But I do see the concerns with that link as it doesn't specify actual cases of soldiers being misdagnosed, rather it just shows that misdiagnosis is a potential concern with TBI patients. –  May 21 '15 at 12:50
  • Let us [continue this discussion in chat](http://chat.stackexchange.com/rooms/23989/discussion-between-noodlemanny-and-awexomecross). – Edward G-Jones May 21 '15 at 12:53
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Could Soldiers really be affected by anxiety and other life factors instead?

Yes. http://www.nytimes.com/2013/02/23/us/drone-pilots-found-to-get-stress-disorders-much-as-those-in-combat-do.html?_r=0 or as described "Oliver Twist"

Then just being in a military complex in a combat zone makes you a target, when you're on patrol or even in the base itself.

Are they overdiagnosed? A simple idea would be to compare the ratio of PTSD diagnosed soliders in different wars. That has various problems mostly: 1) Name-changing and a changes in which symptoms were considered related. E.g. during WWI it was known as shell-shock. 2) Much more through psychological evaluation.

user45891
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    [Welcome to Skeptics!](http://meta.skeptics.stackexchange.com/questions/1505/welcome-to-new-users). This isn't really an answer. You haven't shown that people are been falsely diagnosed. You describe one possible measure you could make, but you don't actually show anyone has made it. – Oddthinking Jul 20 '14 at 19:53