Spectrum of Stress Disorders Emerging?

At the moment only two psychological stress disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM)—acute stress disorder following actual or threatened death or serious injury and posttraumatic stress disorder following the same events.

However, there may be a whole family of psychological stress disorders. This is the suspicion of Matthew Friedman, M.D., Ph.D., executive director of the National Center for Posttraumatic Stress Disorder in White River Junction, Vt., and an expert on PTSD and its treatment.

For instance, Friedman conjectured, psychological stress disorders might result from flunking out of school, losing a job, losing out on love, or getting a divorce.

“Let me give you an anecdote,” he said. “Some years ago I interviewed a man who had had three tours of very heavy fighting in Vietnam. I asked him, ‘What is the worst thing that has ever happened to you?’ He replied, ‘My wife left me.’ So for this man, his wife leaving him was even more traumatic than serving in the war.”

Thus, Friedman predicts that as psychiatrists develop future editions of DSM, they are going to witness the emergence and recognition of a whole spectrum of additional stress disorders. Some will be more intense than others, they may well differ from each other psychobiologically, and they may also require different kinds of psychotherapies or drug therapies, Friedman anticipates.

“Let me remind you,” he said, “that if we look back to the DSM-I, we had only two affective disorders. We had manic-depressive illness, and we had psychotic depression. If you look at the DSM-IV, it is up to eight or nine. So my prediction is that the same thing is going to happen in the field of stress.”