Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A

Posttraumatic stress disorder (PTSD) is a psychiatric pathology wherein the precipitating traumatic event is essential for diagnostic eligibility (Criterion A). This link is substantiated throughout PTSD's development as a diagnosis. However, while traumatic events may vary considerably, this variation currently bears nearly no implications for psychiatric nosology. Consequently, PTSD remains a semi-unified diagnostic construct, consisting of no Criterion-A-determined subtypes of adult PTSD. The question addressed by the current paper is then does one size truly fit all? Making an argument for the negative, the paper briefly reviews complex PTSD (CPTSD), ongoing traumatic stress response (OTSR), and cumulative traumas, all of which are exemplars wherein Criterion A specification is crucial for understanding the emerging symptomatology and for devising appropriate interventions. Indicating several overlooked discrepancies in the PTSD literature, the paper urges for the necessity of a more fine-grained differential diagnostic subtyping of PTSD, wherein posttraumatic reactions are more closely associated with their precipitating traumatic events. The paper concludes by suggesting diagnostic, clinical and societal implications, as well as proposing directions for future research. (C) 2016 Elsevier Ltd. All rights reserved.