Post Traumatic Stress Disorder
Comorbidity: Definition, Anxiety Bipolar Disorder
Both in veterans and in civilian survivors of disaster , PTSD is often found in conjunction with other DSM diagnoses, such as major depression , dysthymia, panic, phobia, alcohol abuse, generalised anxiety disorder, obsessive compulsive disorder (OCD) and somatisation, either at a current or a lifetime base. In clinical samples, PTSD rarely develops as a single syndrome.
It is questionable whether panic, phobia and dysthymia are essentially independent diagnoses with respect to PTSD or, in fact, dimensional morbidity units fitting into broader syndromes. I refer to my remarks on dimensional diagnosis in which I feel supported by Van Praag’s scepticism about traditional comorbidity conceptions.
However, PTSD did occur as an isolated diagnosis in the above-mentioned studies, a phenomenon which existence I can confirm from personal clinical experience. Thus, the question comes back to what the essential functional elements in psychotraumatic syndromes are. To my opinion, these are, first, persistently increased vigilance and, second, the mnemonic elements of what caused this increased vigilance.
These are intricately connected to the neurobiological processes of startle, defence, long-term potentiation, imprinting, kindling and memory intrusion .