US Army needs to sharpen up PTSD diagnosis

Could do better, says the report card of US Army physicians diagnosing post-traumatic stress disorder.

The evaluation comes from a US Army report, published last week, which was prompted by allegations from 14 soldiers whose military physicians had diagnosed them with PTSD. They claim that army officials pressured a medical evaluation board to change their diagnoses to avoid compensating them.

Independent reviewers found that, since 2001, 146,000 behavioural health diagnoses were made that featured an element of PTSD. Of these, 6400 had been altered across the army by evaluation boards, although these were just as frequently changed to PTSD as changed from it. The reviewers agreed with 88 per cent of the PTSD diagnoses that came out of these boards.

Diagnoses between individual physicians can often differ, says Josef Ruzek of the National Center for PTSD in Palo Alto, California. Although there are clear diagnostic criteria for PTSD, evaluations are based almost entirely on soldiers' self-reported symptoms. He says that people are prone to either exaggerate their symptoms ? or minimise them because of concern that a diagnosis will hurt their career. It is not clear which scenario is more common, he says, but evaluations will remain somewhat subjective unless a physiological test for PTSD can be developed.

The army report found no evidence of wrongdoing but says that PTSD evaluation practices are poorly organised and could be improved.

Data from the US Veterans Health Association suggests that 16 per cent of veterans returning from Iraq or Afghanistan have been treated for PTSD since 2001.

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