Is PTSD Over Diagnosed or Misunderstood?
Over the last few decades, post-traumatic stress disorder (PTSD), once thought of as a condition limited to soldiers, has become a critical point in public health discussions.
Among researchers and treatment providers alike, debate continues on whether PTSD is diagnosed too freely or whether the condition is still shrouded in misunderstanding. However, what both sides agree on is that trauma can leave a lasting, sometimes life-threatening mark on those who experience it.
We’re looking at both sides of the argument with one shared goal: to encourage anyone living with trauma to reach out and begin the healing they need and deserve.
How is PTSD defined?
As defined by the NHS, post-traumatic stress disorder (PTSD) is “a mental health condition caused by very stressful, frightening or distressing events.” In some people, it emerges in the immediate aftermath of trauma, while in others it remains dormant until years later.
Clinically, PTSD is recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition rooted in exposure to actual or threatened death, serious injury or sexual violence. PTSD stands as the body and mind’s prolonged stress response, or the system that stays “switched on” long after the danger has passed.
The broad signs and symptoms of PTSD
PTSD is notorious for affecting people in unique ways. Two people can experience the same type of trauma, yet end up with completely different symptoms. We may be able to split PTSD symptoms into four main groups, listed here:
Re-experiencing symptoms
Re-experiencing symptoms are the most common signs of PTSD. Feeling like you’re going through the trauma again can stem from thoughts, feelings, words, locations or objects that remind you of the traumatic event. These appear as:
- Flashbacks to the traumatic event, accompanied by sweating and a high heart rate
- Distressing thoughts or mental images that intrude on your day
- Nightmares and broken sleep with thoughts of the traumatic event
Avoidance symptoms
A person struggling with PTSD can go to great lengths to avoid any and all potential reminders of the time the trauma happened. This can include:
- Convincing yourself that you need to stay busy all the time
- Keeping clear of a place or object that reminds you of the trauma
- A sense of detachment from your body
Reactivity and alertness symptoms
Some of the most direct symptoms of PTSD reflect in how alert or “jittery” you feel, as though you’re always on the lookout for danger. Signs include:
- A pervasive sense of being on guard or on edge, which is also called “hypervigilance” by PTSD specialists
- Difficulty falling or remaining asleep
- Being easily startled or jumpy around others
- Intermittent panic attacks
- Becoming upset in busy environments or with certain sounds
Mood and feeling symptoms
Lastly, PTSD can reflect in your moods and the way you think about yourself. These include:
- Being unable to trust anyone
- Not being able to remember key parts of the traumatic event
- Losing interest in activities and hobbies you previously loved
- Relentless negative emotions, like guilt, shame, fear and sadness
- Being unable to experience positive emotions
The argument for PTSD overdiagnoses
It is undeniable that our understanding and awareness of PTSD has grown in the past few decades. While our collective knowledge of PTSD has helped countless people seek help for their symptoms, it has also ignited some debate between clinicians on the topic of overdiagnosed PTSD, or in diagnoses that don’t fully meet the clinical threshold.
Broadening definitions
One key contributor to this school of thought is in the way its diagnostic criteria have broadened in recent years. Since it was first introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, its definition has certainly expanded. The frameworks used for diagnosing PTSD include emotional and psychological events now, so more people fit today’s criteria than 40 years ago.
Overlaps with other disorders
Diagnostic overlap has also been brought into question by researchers of PTSD and other mental health disorders. Many PTSD symptoms are common within other conditions, like generalised anxiety disorder and adjustment disorder. Without careful trauma-informed assessment, these can be mistaken for PTSD.
A broader reflection on today’s language
Lastly, we might be inclined to take a step back and ask questions about whether the word trauma itself has become a word that is used too easily. It has become part of many casual conversations about stressful, but not necessarily life-threatening, experiences. While it is a positive thing if more people are encouraged to open up about traumatic events, it may indeed be blurring the line between responses to trauma and clinically-diagnosable PTSD.
Why others believe PTSD is misunderstood, not overdiagnosed
The argument that PTSD is still largely misunderstood does carry many valid points. There have certainly been many misunderstandings that leave people undiagnosed, or lead to the misdiagnosis of PTSD as depression, anxiety or personality disorders.
Addressing some of the long-held PTSD myths and outdated beliefs can help ensure that people receive the right diagnosis and the care they deserve:
Advanced screenings find undiagnosed sufferers
Take, as an example, this 2022 BMC Psychiatry broad study of PTSD diagnoses in the United States. Using advanced screening models, their research revealed a significant number of people who were living with untreated PTSD. People were left untreated as they had symptoms which were subtle, internalised or expressed differently than the current textbook definition.
Gender imbalances
There is also a clear argument for gender differences playing a role in PTSD manifestation. Clinical research highlights how women have a two to three times higher risk of developing PTSD than men. They are also more likely to have symptoms of guilt, shame and emotional numbing rather than the overt flashbacks or aggression more commonly seen in men.
Cultural influences
Lastly, there are undeniable cultural factors that shape how a person processes and expresses trauma. This was shown in 2025 research from the Middle East and North Africa. The research shows how different societies have unique cultural concepts of distress (CCDs), or ways of communicating psychological pain that don’t always fit Western diagnostic models. It found that in some cultures, trauma surfaces through “somatic symptoms,” which are physical, such as pain or dizziness, rather than verbal expressions of fear or avoidance.
Ultimately, these findings highlight that what some call “overdiagnosis” may actually reflect a widening awareness of how PTSD truly manifests across cultures, age groups and genders.
Getting the right diagnosis and support
As PTSD shares symptoms with so many other conditions, you must ensure you receive a diagnosis with an adequate amount of time, care and a trauma-informed approach. A qualified mental-health professional will be able to distinguish between the cluster of overlapping symptoms.
Treatment could include trauma-informed therapy, CBT, or EMDR, supported with medication (with a GP’s guidance). It is integral that you don’t self-diagnose or dismiss your symptoms, as they can fester and become stronger over time. Do not hesitate to reach out for help in a time of need.
Where can I find help for PTSD and trauma?
Living with trauma might feel unbearable right now. Even during your darkest hour, please know that the help you deserve is out there.
At Providence Projects, we understand how deeply trauma and mental health intertwine. We specialise in trauma-informed therapy for those living with PTSD and related conditions, such as substance use disorder. If trauma has led you to self-isolate or to find comfort in drugs or alcohol, our team is ready to help you get to grips with the connection and begin your recovery in earnest.
If you’re ready for the next step, our hand is offered out to you. Reach out to Providence Projects today to talk with someone who understands trauma, who can help you take the first step toward understanding PTSD and start your recovery journey.
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If you are looking for rehab to take your, or a loved ones, life back from addiction, look no further than Providence Projects. Reach out to us today to find out how we can help you or a loved one achieve long-term recovery.
(Click here to see works cited)
- NHS Choices, NHS, www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/
- Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
- “Hypervigilance and PTSD.” PTSD UK |, www.ptsduk.org/hypervigilance-and-ptsd/
- “Va.Gov: Veterans Affairs.” PTSD History and Overview, 31 Jan. 2007, www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp.
- Gros DF, Price M, Magruder KM, Frueh BC. Symptom overlap in posttraumatic stress disorder and major depression. Psychiatry Res. 2012 Apr 30;196(2-3):267-70. doi: 10.1016/j.psychres.2011.10.022. Epub 2012 Mar 3. PMID: 22386220; PMCID: PMC3415314.
- “Adjustment Disorder (Stress Response Syndrome): Overview.” WebMD, WebMD, www.webmd.com/mental-health/mental-health-adjustment-disorder.
- Gagnon-Sanschagrin, Patrick, et al. “Identifying Individuals with Undiagnosed Post-Traumatic Stress Disorder in a Large United States Civilian Population – A Machine Learning Approach – BMC Psychiatry.” BioMed Central, BioMed Central, 29 Sept. 2022, bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04267-6.
- Olff M. Sex and gender differences in post-traumatic stress disorder: an update. Eur J Psychotraumatol. 2017 Sep 29;8(sup4):1351204. doi: 10.1080/20008198.2017.1351204. PMCID: PMC5632782.
- How Is Trauma-Related Distress Experienced and Expressed in Populations from the Greater Middle East and North Africa? A Systematic Review of Qualitative Literature – Sciencedirect, www.sciencedirect.com/science/article/pii/S2666560323000737.
- Aacap. Physical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders, www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Physical_Symptoms_of_Emotional_Distress-Somatic_Symptoms_and_Related_Disorders-124.aspx