Subtle presentations of post-traumatic stress disorder: Diagnostic issues

The authors present a set of diagnostic procedures designed to detect subtle presentations of post-traumatic stress disorder (PTSD). Defined as a Type II diagnostic error (a false negative), the authors examine several sources of subtle presentations of PTSD. These include imperfect diagnostic instruments, high base rates, imperfect memory of critical events, imperfect reporting of signs and symptoms, imperfect interpretation of presented signs and symptoms, and diagnostic decisions based on informal clinical judgment. The authors believe that a multistage diagnostic procedure, using instruments with known psychometric properties while simultaneously looking for converging evidence is the best safeguard against missing an appropriate diagnosis of posttraumatic stress disorder.