Subtle presentations of post-traumatic stress disorder - Diagnostic issues

The authors present a set of diagnostic procedures designed to detect subtl e presentations of post-traumatic stress disorder (PTSD). Defined as a Type II diagnostic error (a false negative), the authors examine several source s of subtle presentations of PTSD. These include imperfect diagnostic instr uments, high base rates, imperfect memory of critical events, imperfect rep orting of signs and symptoms, imperfect interpretation of presented signs a nd symptoms, and diagnostic decisions based on informal clinical judgment. The authors believe that a multistage diagnostic procedure, using instrumen ts with known psychometric properties while simultaneously looking for conv erging evidence is the best safeguard against missing an appropriate diagno sis of posttraumatic stress disorder.