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Comment & Response
November 2016

Changes to the Definition of Posttraumatic Stress Disorder in the DSM-5—Reply

Author Affiliations
  • 1Walter Reed Army Institute of Research, Silver Spring, Maryland
JAMA Psychiatry. 2016;73(11):1202-1203. doi:10.1001/jamapsychiatry.2016.2381

In Reply My coauthors and I thank Guina for his comments concerning the recent debate articles on the DSM-5 posttraumatic stress disorder (PTSD) definition. However, we disagree with Guina’s basic premise that these diametrically opposed positions1,2 can be reconciled by viewing them as both correct. Conflict of this nature is uncomfortable, but glossing over differences in viewpoints among experts does further disservice to patients and especially to service members and veterans for whom the military occupational context adds considerably more implications to receiving (or not receiving) the PTSD diagnosis. This is a problem that demands scientific rigor. To counter Guina’s attempt at bridging the divide, I think it’s fair to point out that in contrast to our well-substantiated stand-alone position article authored by 12 leading experts from across the world (with substantial military expertise),1 the rebuttal by Friedman et al2 was largely an effort to defend a flawed consensus process. Every reference Friedman et al2 cited to support their position also supported ours.1 We are confident that when readers scrutinize the accuracy of these arguments and references in the context of clinical care (particularly for military and Veterans Affairs), it will be clear which position is defensible.

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