and Mastery of Obsessive-Compulsive Disorders: A
Cognitive-Behavioral Approach Therapist Guide. Dr.
Foa, long recognized for her expertise in this field,
was appointed to chair the committees that worked
on the PTSD and OCD chapters in the fourth and
fifth editions of the Diagnostic and Statistical Manual
of Mental Disorders (DSM) (DSM-IV and DSM-V).
The DSM-V, published by the American Psychiatric
Association, offers a common language and standard
criteria for the classification of mental disorders.
Chief Tustin: How is PTSD diagnosed? Is it a
purely from a psychological assessment or are there
physical symptoms that can be tested/assessed? Are
we closer to any biological markers?
Dr. Foa: A physical exam is conducted to rule out
a medical reason for a person’s problems. This is followed by a psychological exam to assess the person’s
signs and symptoms and a review of events that led to
them. Psychologists and psychiatrists use the questions
and criteria that are outlined in the DSM-V for the
assessment and to make a diagnosis. The diagnosis is
not based exclusively on the questions. The interview
includes many questions about daily functioning.
The criterion also requires an evaluation of the
event, as it is equally important. The person’s trau-
matic experience is generally a near-death injury, a
life-threatening event (often with an element of vio-
lence), or some sort of sexual abuse. A person could
also experience PTSD if he or she witnessed any of
those events. Finally, the last criterion for the diagno-
sis is it also must be interfering with the person’s life.
There are currently no biological markers available
to test for PTSD. However, doctors closely monitor
for physical reactions during the interview (elevated
heart rate, pallor, tremors, emotional outbreaks).
Tustin: How does a healthcare professional differentiate between PTSD and a cumulative stress
Foa: The thoroughness of the questions within
the DSM–V helps to differentiate between the two;
the person’s reactions during the assessment; and, of
course, the presence of a serious traumatic event. You
must also be experiencing the signs and symptoms
for a prolonged period of time.
Tustin: What is the prognosis for someone with
PTSD? Do you have it for life? Or, can you be completely cured with the proper treatment?
Foa: If people can get help quickly, and if PTSD
can be diagnosed within the first month, the rate of
cure is extremely high. Some people may have some
residual symptoms left, but they are easily dealt with.
For the majority of patients with early treatment,
all the symptoms go away. Unfortunately, if PTSD
goes undiagnosed for a year or more, treatment takes