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.