Skip to main content

Advertisement

SpringerLink
Log in

One Quintillion Ways to Have PTSD Comorbidity: Recommendations for the Disordered DSM-5

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

Galatzer-Levy and Bryant (Perspect Psychol Sci 8:651–662, 2013) have calculated the number of ways that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) posttraumatic stress disorder (PTSD) symptoms can be combined as over 600,000. They concluded that the amount is astounding and the category is rendered amorphous. PTSD often occurs in the context of polytrauma or comorbidity. The epidemiological literature indicates that the most common comorbid conditions in cases of PTSD include major depressive disorder (MDD), chronic pain, neurocognitive disorder due to traumatic brain injury (e.g., mild), and alcohol use disorder, with premorbid personality disorder possible, as well (which we consider as exacerbated due to the traumatic incident at issue, as in borderline personality disorder). We calculated the possible symptom combinations for each of these disorders and then in comorbid combination with PTSD (e.g., PTSD with MDD, but also when all six conditions are present). The number of symptom combinations in full polytrauma involving all six conditions listed is truly astounding, over one quintillion. Also, we reviewed the range of PTSD comorbidities, which adds to the symptom heterogeneity in cases. We make recommendations to prioritize symptoms in disorders as primary (e.g., unique, marker), secondary (e.g., core essential), and tertiary (e.g., common, cross-diagnostic). The latter tertiary type of symptoms in a disorder, if any, should be kept apart in its own criterion. This approach might help make the next version of the DSM more clinically useful both to clinicians and to court.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Armour, C., Carragher, N., & Elhai, J. D. (2013). Assessing the fit of the dysphoric arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC. Journal of Anxiety Disorders, 27, 109–115.

    Article  PubMed  Google Scholar 

  • Berntsen, D., Johannessen, K. B., Thomsen, Y. D., Bertelsen, M., Hoyle, R. H., & Rubin, D. C. (2012). Peace and war trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan. Psychological Science, 23, 1557–1565.

    Article  PubMed Central  PubMed  Google Scholar 

  • Biehn, T. L., Elhai, J. D., Seligman, L. D., Tamburrino, M., & Forbes, D. (2013). Underlying dimensions of DSM-5 posttraumatic stress disorder and major depressive disorder symptoms. Psychological Injury and Law, 6, 290–298.

    Article  Google Scholar 

  • Blanchard, E. B., Hickling, E. J., Freidenberg, B. M., Malta, L. S., Kuhn, E., & Skyes, M. A. (2004). Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash. Behaviour Research and Therapy, 42, 569–583.

    Article  PubMed  Google Scholar 

  • Bonanno, G. A., Mancini, A. D., Horton, J. L., Powell, T. M., LeardMann, C. A., Boyko, E. J., Wells, T. S., Hopper, T. I., Gackstetter, G. D., & Smith, T. C. (2012). Trajectories of trauma symptoms and resilience in deployed U.S. military service members: Prospective cohort study. British Journal of Psychiatry: The Journal of Mental Science, 200, 317–323.

    Google Scholar 

  • Borsboom, D. (2008). Psychometric perspectives on diagnostic systems. Journal of Clinical Psychology, 64, 1089–1108.

    Article  PubMed  Google Scholar 

  • Brewin, C. R., Lanius, R. A., Novac, A., Schnyder, U., & Galea, S. (2009). Reformulating PTSD for DSM-V: Life after criterion A. Journal of Traumatic Stress, 22, 366–373.

    Article  PubMed  Google Scholar 

  • Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.

    Article  PubMed  Google Scholar 

  • Cain, F. (2013). How many stars are there in the universe? Retrieved from http://www.universetoday.com/102630/

  • Chilcoat, H. D., & Breslau, N. (1998). Investigations of causal pathways between PTSD and drug use disorders. Addictive Behavior, 23, 827–840.

    Article  Google Scholar 

  • Daskalakis, N. P., Lehrner, A., & Yehuda, R. (2013). Endocrine aspects of posttraumatic stress disorder and implications for diagnosis and treatment. Endocrinology and Metabolism Clinics of North America, 42, 503–513.

    Article  PubMed  Google Scholar 

  • Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786 (1993).

  • de Roon-Cassini, T. A. (2010). Psychopathology and resilience following traumatic injury: A latent growth mixture model analysis. Rehabilitation Psychology, 55, 1–11.

    Article  Google Scholar 

  • Dolich, M. O., & Hoyt, D. B. (2008). Treatment of physical injury, acute pain and disability consequent to motor vehicle collisions. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 61–81). San Diego: Elsevier.

    Chapter  Google Scholar 

  • Duckworth, M. P. (2008). Psychological conditions associated with motor vehicle collisions. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 311–344). San Diego: Elsevier.

    Chapter  Google Scholar 

  • Duckworth, M. P., Iezzi, T., & O’Donohue, W. T. (2008a). Motor vehicle collisions: Medical, psychosocial, and legal consequences. San Diego: Elsevier.

    Google Scholar 

  • Duckworth, M. P., Iezzi, T., & O’Donohue, W. T. (2008b). Introduction. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 3–12). San Diego: Elsevier.

    Google Scholar 

  • Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011). Evidence for a unique PTSD construct represented by PTSD’s D1–D3 symptoms. Journal of Anxiety Disorders, 25, 340–345.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Franklin, C. L., & Gray, M. J. (2008). The SCID PTSD module’s trauma screen: Validity with two samples in detecting trauma history. Depression and Anxiety, 25, 737–741.

    Article  PubMed  Google Scholar 

  • Erikson, D. J., Wolfe, J., King, D. W., King, L. A., & Sharkansky, E. J. (2001). Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: A prospective analysis. Journal of Consulting and Clinical Psychology, 69, 41–49.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). User’s guide for the structured clinical interview for DSM-IV axis I disorders (SCID-I: Clinician). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Forbes, D., Haslam, N., Williams, B. J., & Creamer, M. (2005). Testing the latent structure of posttraumatic stress disorder: A taxometric study of combat veterans. Journal of Traumatic Stress, 18, 647–656.

    Article  PubMed  Google Scholar 

  • Forbes, D., Parslow, R., Creamer, M., O’Donnell, M., Bryant, R., McFarlane, A., Silove, D., & Shalev, A. (2010). A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with fear and anxious-misery disorders: Implications for DSM-V. Journal of Affective Disorders, 127, 147–152.

    Google Scholar 

  • Galatzer-Levy, I. R., & Bryant, R. A. (2013). 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science, 8, 651–662.

    Article  Google Scholar 

  • Galatzer-Levy, I. R., Madan, A., Neylan, T. C., Henn-Haase, C., & Marmar, C. R. (2011). Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms. Journal of Traumatic Stress, 24, 557–565.

    Article  PubMed  Google Scholar 

  • Galatzer-Levy, I. R., Nickerson, A., Litz, B. T., & Marmar, C. R. (2013). Patterns of lifetime PTSD comorbidity: A latent class analysis. Depression and Anxiety, 30, 489–496.

    Article  PubMed  Google Scholar 

  • General Electric v. Joiner, 522 U.S. 136 (1997).

  • Gottesman, I. I., & Gould, T. D. (2003). The endophenotype concept in psychiatry: Etymology and strategic intentions. American Journal of Psychiatry, 160, 636–645.

    Google Scholar 

  • Hamanaka, S., Asukai, N., Kamijo, Y., Hatta, K., Kishimoto, J., & Miyaoka, H. (2006). Acute stress disorder and posttraumatic stress disorder symptoms among patients severely injured in motor vehicle accidents in Japan. General Hospital Psychiatry, 28, 234–241.

    Article  PubMed  Google Scholar 

  • Horn, C. A. C., Pietrzak, R. H., Corsi-Travali, S., & Neumeister, A. (2014). Linking plasma cortisol levels to phenotypic heterogeneity of posttraumatic stress symptomatology. Psychoneuroendocrinology, 39, 88–93.

    Article  PubMed  Google Scholar 

  • Hruska, B., & Delahanty, D. L. (2012). Application of the stressor vulnerability model to understanding posttraumatic stress disorder (PTSD) and alcohol-related problems in an undergraduate population. Psychology of Addictive Behaviors, 26, 734–746.

    Article  PubMed  Google Scholar 

  • Hruska, B., & Delahanty, D. L. (2014). PTSD-SUD biological mechanisms: Self-medication and beyond. In P. Ouimette & J. P. Read (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (2nd ed., pp. 35–52). Washington, DC: American Psychiatric Association.

    Chapter  Google Scholar 

  • Hruska, B., Fallon, W., Spoonster, E., Sledjeski, E. M., & Delahanty, D. L. (2011). Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress disorder. Psychology of Addictive Behaviors, 25, 405–414.

    Article  PubMed Central  PubMed  Google Scholar 

  • Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C. S., & Wang, P. (2010). Research domain criteria: Toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167, 748–751.

    Google Scholar 

  • Iverson, G. L., Brooks, B. L., & Ashton, V. L. (2008). Cognitive impairment consequent to motor vehicle collisions: Foundations for clinical and forensic practice. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 243–309). San Diego: Elsevier.

    Chapter  Google Scholar 

  • Jovanovic, T., Kazama, A., Bachevalier, J., & Davis, M. (2012). Impaired safety signal learning may be a biomarker of PTSD. Neuropharmacology, 62, 695–704.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kessler, R. C., McGonagle, K. A., Nelson, C. B., Hughes, M., Swartz, M., & Blazer, D. G. (1994). Sex and depression in the National Comorbidity Survey II: Cohort effects. Journal of Affective Disorders, 30, 15–26.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Petukhova, M., & Zaslavsky, A. M. (2011). The role of latent internalizing and externalizing predispositions in accounting for the development of comorbidity among common mental disorders. Current Opinion in Psychiatry, 24, 307–312.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.

    Article  PubMed  Google Scholar 

  • Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.

    Article  PubMed  Google Scholar 

  • King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90–96.

    Article  Google Scholar 

  • Kramer, M. D., Polusny, M. A., Arbisi, P. A., & Krueger, R. F. (2014). Comorbidity of PTSD and SUDs: Toward and etiologic understanding. In P. Ouimette & J. P. Read (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (2nd ed., pp. 53–75). Washington, DC: American Psychiatric Association.

    Chapter  Google Scholar 

  • Krause, E. D., Kaltman, S., Goodman, L. A., & Dutton, M. A. (2008). Avoidant coping and PTSD symptoms related to domestic violence exposure: A longitudinal study. Journal of Traumatic Stress, 21, 83–90.

    Article  PubMed  Google Scholar 

  • Kumho Tire Company v. Carmichael, 526 U.S. 137 (1999).

  • Lareau, C. R. (2011). Posttraumatic stress disorder and acute stress disorder. In D. Faust (Ed.), Coping with psychiatric and psychological testimony (6th ed., pp. 610–635). New York: Oxford University Press.

    Google Scholar 

  • Lockwood, E., & Forbes, D. (2014). Posttraumatic stress disorder and comorbidity: Untangling the Gordian knot. Psychological Injury and Law, in press.

  • Lynn, S. J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht, T., & van der Kloet, D. (2012). Dissociation and dissociative disorders: Challenging conventional wisdom. Current Directions in Psychological Science, 21, 48–53.

    Article  Google Scholar 

  • Malleson, A. (2002). Whiplash and other useful illnesses. Montreal: McGill Queen’s University Press.

    Google Scholar 

  • Malta, L. S., Blanchard, E. B., Taylor, A. E., Hickling, E. J., & Freidenberg, B. M. (2002). Personality disorders in posttraumatic stress disorder and motor vehicle accident survivors. Journal of Nervous and Mental Disease, 190, 767–774.

    Article  PubMed  Google Scholar 

  • Marshall, R. D., Olfson, M., Hellman, F., Blanco, C., Guardino, M., & Struening, E. L. (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. American Journal of Psychiatry, 158, 1467–1473.

    Article  PubMed  Google Scholar 

  • Mayou, R., & Bryant, B. (2002). Outcome 3 years after a road traffic accident. Psychological Medicine, 32, 671–675.

    PubMed  Google Scholar 

  • McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2009). Can we fix PTSD in DSMV? Depression and Anxiety, 26, 597–600.

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2012). Are we winning the war against posttraumatic stress disorder? Science, 336, 872–874.

    Article  PubMed  Google Scholar 

  • McTeague, L. M., Lang, P. J., Laplante, M. C., Cuthbert, B. M. N., Stauss, C. C., & Bradley, M. M. (2009). Fearful imagery in social phobia: Generalization, comorbidity, and physiological reactivity. Biological Psychiatry, 65, 374–382.

    Article  PubMed Central  PubMed  Google Scholar 

  • Milad, M. R., Orr, S. P., Lasko, N. B., Chang, Y., Rauch, S. L., & Pitman, R. K. (2008). Presence and acquired origin of reduced recall for fear extinction in PTSD: Results of a twin study. Journal of Psychiatric Research, 42, 515–520.

    Article  PubMed Central  PubMed  Google Scholar 

  • Miller, M. W., Wolf, E. J., Kilpatrick, D., Resnick, H., Marx, B. P., Holowka, D. W., Keane, T. M., Rosen, R. C., & Friedman, M. I. (2012). The prevalence and latent structure of proposed DSM-5 posttraumatic stress disorder symptoms in U. W. national and veteran samples. Psychological Trauma: Theory, Research, Practice, and Policy. doi:10.1037/a0029730

  • Muthén, B., & Muthén, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and Experimental Research, 24, 882–891.

    Article  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998). Mplus user’s guide. Los Angeles: Muthén and Muthén.

    Google Scholar 

  • Muthén, L. K., & Muthén, B. (2006). Mplus user’s guide (4th ed.). Los Angeles: Muthén and Muthén.

    Google Scholar 

  • Müller, M., Vandeleur, C., Rodgers, S., Rössler, W., Castelao, E., Preisig, M., & Ajdacic-Gross, V. (2014). Factors associated with comorbidity patterns in full and partial PTSD: Findings from the PsyCoLaus study. Comprehensive Psychiatry, in press.

  • O’Donnell, M. L., Creamer, M., & Pattison, P. (2004a). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry, 161, 1390–1396.

    Article  PubMed  Google Scholar 

  • O’Donnell, M. L., Creamer, M., Pattison, P., & Atkin, C. (2004b). Psychiatric morbidity following injury. American Journal of Psychiatry, 161, 507–514.

    Article  PubMed  Google Scholar 

  • O’Donnell, M. L., Creamer, M., & Ludwig, G. (2008). PTSD and associated mental health consequences of motor vehicle collisions. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 345–363). San Diego: Elsevier.

    Chapter  Google Scholar 

  • Ouimette, P., & Read, J. P. (2014). Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (2nd ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.

    Article  PubMed  Google Scholar 

  • Panagioti, M., Gooding, P., Taylor, P. T., & Tarrier, N. (2013). A model of suicidal behavior in posttraumatic stress disorder (PTSD): The mediating role of defeat and entrapment. Psychiatric Research, 209, 55–59.

    Article  Google Scholar 

  • Pietrzak, R. H., Galea, S., Southwick, S. M., & Gelernter, J. (2013). Examining the relation between the serotonin transporter 5-HTTPLR genotype x trauma exposure interaction on a contemporary phenotypic model of posttraumatic stress symptomatology: A pilot study. Journal of Affective Disorders, 148, 123–128.

    Article  PubMed  Google Scholar 

  • Pietrzak, R. H., Tsai, J., Harpaz-Rotem, I., Whealin, J. M., & Southwick, S. M. (2012). Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: A confirmatory factor analytic study. Journal of Psychiatric Research, 46, 317–322.

    Article  PubMed  Google Scholar 

  • Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133, 725.

    Article  PubMed  Google Scholar 

  • Post, L. M., Zoellner, L. A., Youngstrom, E., & Feeny, N. C. (2011). Understanding the relationship between co-occurring PTSD and MDD: Symptom severity and affect. Journal of Anxiety Disorders, 25, 1123–1130.

    Article  PubMed Central  PubMed  Google Scholar 

  • Reed, P. L., Anthony, J. C., & Breslau, N. (2007). Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: Do early life experiences and predispositions matter? Archives of General Psychiatry, 64, 1435–1442.

    Article  PubMed  Google Scholar 

  • Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, part II: Test–retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59–70.

    Google Scholar 

  • Richmond, T. S., & Jacoby, S. (2008). Emergency department trauma: The immediate aftermath of motor vehicle collisions. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 83–106). San Diego: Elsevier.

    Chapter  Google Scholar 

  • Rytwinski, N. K., Scur, M. D., Feeny, N. C., & Youngstrom, E. A. (2013). The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: A meta-analysis. Journal of Traumatic Stress, 26, 299–309.

    Article  PubMed  Google Scholar 

  • Schnyder, U., Moergeli, H., Klaghofer, R., & Buddeberg, C. (2001). Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. American Journal of Psychiatry, 158, 594–599.

    Article  PubMed  Google Scholar 

  • Seeley, J. R., Kosty, D. B., Farmer, R. F., & Lewinsohn, P. M. (2011). The modeling of internalizing disorders on the basis of patterns of lifetime comorbidity: Associations with psychosocial functioning and psychiatric disorders among first-degree relatives. Journal of Abnormal Psychology, 120, 308–321.

    Article  PubMed  Google Scholar 

  • Sequeira, K. A. J., Sangha, H., Gnanakumar, V., Pretty, J., & Teasell, R. (2008). Managing MVC-related sequelae in the primary care setting: Normalizing experiences of acute pain and injury-related impairment. In M. P. Duckworth, T. Iezzi, & W. T. O’Donohue (Eds.), Motor vehicle collisions: Medical, psychosocial, and legal consequences (pp. 131–166). San Diego: Elsevier.

    Google Scholar 

  • Shevlin, M., & Elklit, A. (2012). The latent structure of posttraumatic stress disorder: Different models or different populations? Journal of Abnormal Psychology, 121, 610–615.

    Article  PubMed  Google Scholar 

  • Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647.

    Article  PubMed  Google Scholar 

  • Swendsen, J., Conway, K. P., Degendardt, L., Glantz, M., Jin, R., Merikangas, K. R., Sampson, N., & Kessler, R. C. (2010). Mental disorders as risk factors for substance use, abuse, and dependence: Results from the 10-year follow-up of the National Comorbidity Survey. Addiction, 105, 1117–1128.

  • Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959–992.

    Article  PubMed  Google Scholar 

  • Vaidyanathan, U., Patrick, C. J., & Iacono, W. G. (2011). Patterns of comorbidity among mental disorders: A person-centered approach. Comprehensive Psychiatry, 52, 527–535.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Dokkum, P., & Conroy, C. (2010). A substantial population of low-mass stars in luminous elliptical galaxies. Nature, 468, 940–942.

    Article  PubMed  Google Scholar 

  • Wolf, E. J., Miller, M. W., Krueger, R. F., Lyons, M. J., Tsuang, M. T., & Koenen, K. C. (2010). Posttraumatic stress disorder and the genetic structure of comorbidity. Journal of Abnormal Psychology, 119, 320–330.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wolf, E. J., Millers, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D., & Freund, R. (2012). A latent class analysis of dissociation and PTSD: Evidence for a dissociative subtype. Archives of General Psychiatry, 69, 698–705.

    Article  PubMed Central  PubMed  Google Scholar 

  • Yehuda, R. (2004). Risk and resilience in posttraumatic stress disorder. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Yehuda, R., & Bierer, L. M. (2005). Re-evaluating the link between disasters and psychopathology. In J. J. Lopex-Ibor, G. Christodoulou, M. Maj, N. Sartorius, & A. Okasha (Eds.), Disasters and mental health (pp. 65–80). New York: Wiley.

    Chapter  Google Scholar 

  • Young, G. (2011). Development and causality: Neo-Piagetian perspectives. New York: Springer Science + Business Media.

  • Young, G. (2013). Breaking bad: DSM-5 description, criticism, and recommendations. Psychological Injury and Law, 6, 345–348.

    Google Scholar 

  • Young, G. (2014a). Malingering, feigning, and response bias in psychiatric/psychological injury: Implications for practice and court. International Library of Ethics, Law, and New Medicine, 56. Dordrecht: Springer.

    Book  Google Scholar 

  • Young, G. (2014b). PTSD, endophenotypes, the RDoC, and the DSM-5. Psychological Injury and Law, 7. doi:10.1007/s12207-014-9187-x.

  • Young, G., & Haynes, S. (2014). Causality in normal and abnormal behavior: Emergence in development, biology, brain, mind, and free will. New York: Springer.

    Google Scholar 

  • Young, G., & Yehuda, R. (2006). Understanding PTSD: Implications for court. In G. Young, A. W. Kane, & K. Nicholson (Eds.), Psychological knowledge in court: PTSD, pain, and TBI (pp. 55–69). New York: Springer.

    Chapter  Google Scholar 

  • Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119, 764–776.

    Article  PubMed  Google Scholar 

  • Zlotnick, C., Johnson, D. M., Yen, S., Battle, C. L., Sanislow, C. A., Skodol, A. E., Grilo, C. M., McGlashan, T. H., Gunderson, J. G., Bender, D. S., Zarnarini, M. C., & Shea, M. T. (2003). Clinical features and impairment in women with borderline personality disorder (BPD) with posttraumatic stress disorder (PTSD), BPD without PTSD, and other personality disorders with PTSD. Journal of Nervous and Mental Disorders, 191, 706–714.

    Google Scholar 

  • Zoellner, L. A., Bedard-Gilligan, M. A., Jun, J. J., Marks, L. H., & Garcia, N. M. (2013). The evolving construct of posttraumatic stress disorder (PTSD): DSM-5 criteria changes and legal implications. Psychological Injury and Law, 6, 277–289.

    Google Scholar 

  • Zoellner, L. A., Pruitt, L. D., Farach, F. J., & Jun, J. J. (2014). Understanding heterogeneity in PTSD: Fear, dysphoria, and distress. Depression and Anxiety, 31, 97–106.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

Note that we have no conflicts of interest to report. Patrick Palmieri and Jon Elhai served as action editors for the article. The first author is responsible for writing the article. We greatly appreciated the review comments and corrections.

Author information

Authors and Affiliations

  1. Glendon College, York University, Toronto, ON, Canada

    Gerald Young & Brandon Pierre

  2. Patton State Hospital, Patton, CA, USA

    Craig Lareau

Authors
  1. Gerald Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Craig Lareau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brandon Pierre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerald Young.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Young, G., Lareau, C. & Pierre, B. One Quintillion Ways to Have PTSD Comorbidity: Recommendations for the Disordered DSM-5. Psychol. Inj. and Law 7, 61–74 (2014). https://doi.org/10.1007/s12207-014-9186-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-014-9186-y

Keywords

Search

Navigation