Posttraumatic Stress Disorder Differential Diagnoses
- Author: T Allen Gore, MD, MBA, CMCM, DFAPA; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK) more...
Diagnostic Considerations
Acute stress disorder
Adjustment disorder
Malingering (must be excluded)
Mood disorder with psychotic features
Psychotic disorders caused by a general medical condition
Substance-induced disorders
A review of PTSD trials in refugees suggested that PTSD may be a culture-specific diagnosis.[12] Care must be taken by a health care professional when applying this diagnosis to people from non-Western cultures where the diagnosis has not been validated and standard PTSD assessments have not been adapted to express non-Western concepts of disorder and idioms of distress.
Differential Diagnoses
- Anxiety Disorders
- Obsessive-Compulsive Disorder
- Schizophrenia
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-VI-TR. In: Anxiety Disorders. Washington, DC: American Psychiatric Association; 2000:463-8.
Risser HJ, Hetzel-Riggin MD, Thomsen CJ, McCanne TR. PTSD as a mediator of sexual revictimization: the role of reexperiencing, avoidance, and arousal symptoms. J Trauma Stress. Oct 2006;19(5):687-98. [Medline].
Yaffe K, Vittinghoff E, Lindquist K, Barnes D, Covinsky KE, Neylan T, et al. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry. Jun 2010;67(6):608-13. [Medline]. [Full Text].
Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, et al. Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. Jun 2010;167(6):640-7. [Medline].
Medina J. Stress, PTSD and the Hippocampus. Presented at: 16th Annual US Psychiatric and Mental Health Congress. Orlando, FL: November 6-9, 2003.
Smith ME. Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: a meta-analysis of structural MRI studies. Hippocampus. 2005;15(6):798-807. [Medline].
de Quervain DJ, Margraf J. Glucocorticoids for the treatment of post-traumatic stress disorder and phobias: a novel therapeutic approach. Eur J Pharmacol. Apr 7 2008;583(2-3):365-71. [Medline].
Krahé B, Scheinberger-Olwig R, Waizenhöfer E, Kolpin S. Childhood sexual abuse and revictimization in adolescence. Child Abuse Negl. Apr 1999;23(4):383-94. [Medline].
Deykin EY. Posttraumatic Stress Disorder in Childhood and Adolescence: A Review. 1999. Medscape Mental Health [online]. Available at http://medscape.com.
Marshall RD, Pierce D. Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy. Harv Rev Psychiatry. Jan-Feb 2000;7(5):247-56. [Medline].
Milad MR, Orr SP, Lasko NB, Chang Y, Rauch SL, Pitman RK. Presence and acquired origin of reduced recall for fear extinction in PTSD: results of a twin study. J Psychiatr Res. Jun 2008;42(7):515-20. [Medline]. [Full Text].
Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev. Jan 2008;28(1):36-47. [Medline].
Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. Mar 1 2006;295(9):1023-32. [Medline].
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. Jul 1 2004;351(1):13-22. [Medline].
Polusny MA, Kehle SM, Nelson NW, Erbes CR, Arbisi PA, Thuras P. Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Arch Gen Psychiatry. Jan 2011;68(1):79-89. [Medline].
American Psychiatric Association. High Percentage of Youth in the U.S. Report Symptoms of Posttraumatic Stress and Other Disorders [press release]. Washington, DC: American Psychiatric Association; Aug 3 2003.
Hoge CW, Clark JC, Castro CA. Commentary: women in combat and the risk of post-traumatic stress disorder and depression. Int J Epidemiol. Apr 2007;36(2):327-9. [Medline].
Rona RJ, Fear NT, Hull L, Wessely S. Women in novel occupational roles: mental health trends in the UK Armed Forces. Int J Epidemiol. Apr 2007;36(2):319-26. [Medline].
Fiszman A, Mendlowicz MV, Marques-Portella C, Volchan E, Coutinho ES, Souza WF, et al. Peritraumatic tonic immobility predicts a poor response to pharmacological treatment in victims of urban violence with PTSD. J Affect Disord. Apr 2008;107(1-3):193-7. [Medline].
National Institute of Mental Health. Helping Children and Adolescents Cope with Violence and Disasters. NIH Publication No. 01-3518. Bethesda, Md:. National Institute of Mental Health; 2001:[Full Text].
Sonne SC, Back SE, Diaz Zuniga C, Randall CL, Brady KT. Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder. Am J Addict. Oct-Dec 2003;12(5):412-23. [Medline].
Schwartz AC, Bradley R, Penza KM, Sexton M, Jay D, Haggard PJ, et al. Pain medication use among patients with posttraumatic stress disorder. Psychosomatics. Mar-Apr 2006;47(2):136-42. [Medline]. [Full Text].
Olsson KA, Kenardy JA, De Young AC, Spence SH. Predicting children's post-traumatic stress symptoms following hospitalization for accidental injury: combining the Child Trauma Screening Questionnaire and heart rate. J Anxiety Disord. Dec 2008;22(8):1447-53. [Medline].
Dickie EW, Brunet A, Akerib V, Armony JL. An fMRI investigation of memory encoding in PTSD: influence of symptom severity. Neuropsychologia. Apr 2008;46(5):1522-31. [Medline].
Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Mental health treatment received by primary care patients with posttraumatic stress disorder. J Clin Psychiatry. Oct 2003;64(10):1230-6. [Medline].
Kasai K, Yamasue H, Gilbertson MW, Shenton ME, Rauch SL, Pitman RK. Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder. Biol Psychiatry. Mar 15 2008;63(6):550-6. [Medline]. [Full Text].
Högberg G, Pagani M, Sundin O, Soares J, Aberg-Wistedt A, Tärnell B, et al. Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up. Psychiatry Res. May 30 2008;159(1-2):101-8. [Medline].
Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety. 2009;26(12):1086-109. [Medline].
Bronson D, Franco K, Budur K. Posttraumatic stress disorder in primary care patients. Compr Ther. Winter 2007;33(4):208-15. [Medline].
Nijdam MJ, Gersons BP, Reitsma JB, de Jongh A, Olff M. Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: randomised controlled trial. Br J Psychiatry. Mar 2012;200(3):224-31. [Medline].
Litz BT, Engel CC, Bryant RA, Papa A. A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. Am J Psychiatry. Nov 2007;164(11):1676-83. [Medline].
Germain A, Shear MK, Hall M, Buysse DJ. Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behav Res Ther. Mar 2007;45(3):627-32. [Medline].
Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. Apr 15 2007;61(8):928-34. [Medline].
Lambert MT. Aripiprazole in the management of post-traumatic stress disorder symptoms in returning Global War on Terrorism veterans. Int Clin Psychopharmacol. May 2006;21(3):185-7. [Medline].
Bandelow B. Defining response and remission in anxiety disorders: toward an integrated approach. CNS Spectr. Oct 2006;11(10 Suppl 12):21-8. [Medline].
Connor KM, Davidson JR. Further psychometric assessment of the TOP-8: a brief interview-based measure of PTSD. Depress Anxiety. 1999;9(3):135-7. [Medline].
Hamilton A. Diagnosis and rating of anxiety. Special Publication: Br J Psychiatry; 1969:3:76-79.
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. Dec 1967;6(4):278-96. [Medline].
Sheehan DV, Harnett-Sheehan K, Raj BA. The measurement of disability. Int Clin Psychopharmacol. Jun 1996;11 Suppl 3:89-95. [Medline].
Connor KM, Sutherland SM, Tupler LA, Malik ML, Davidson JR. Fluoxetine in post-traumatic stress disorder. Randomised, double-blind study. Br J Psychiatry. Jul 1999;175:17-22. [Medline].
Davis LL, Frazier EC, Williford RB, Newell JM. Long-term pharmacotherapy for post-traumatic stress disorder. CNS Drugs. 2006;20(6):465-76. [Medline].
Pollack MH, Hoge EA, Worthington JJ, et al. Eszopiclone for the treatment of posttraumatic stress disorder and associated insomnia: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. Jul 2011;72(7):892-7. [Medline].
Brunet A, Orr SP, Tremblay J, Robertson K, Nader K, Pitman RK. Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder. J Psychiatr Res. May 2008;42(6):503-6. [Medline].
Krystal JH, Rosenheck RA, Cramer JA, Vessicchio JC, Johnes, KM, et al. Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD. JAMA. Aug 2011;306(5):461-568.
[Best Evidence] Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S. Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry. Feb 2007;190:97-104. [Medline].
Bremner JD. Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clin N Am. Nov 2007;17(4):523-38, ix. [Medline]. [Full Text].

