Beyond Categorical Classifications: The Importance of Identifying Posttrauma Symptom Trajectories and Associated Negative Outcomes

Soldiers returning from deployment: A qualitative study regarding exposure, coping, and reintegration.

“…Despite continued efforts within both clinical and research circles to identify strategies and methods to facilitate differential diagnosis of mTBI versus PTSD, the present findings support emerging theories regarding reconceptualizing responses to physical and emotional trauma. Although individuals were recruited on the basis of differential diagnostic criteria, and there were analytic plans to examine differences between subgroups, such differences were not identified, thus providing additional support for conceptualizing trauma cumulatively and dimensionally and in the context of biological, psychological, and social factors that affect development over a lifetime (Nazem, Spitzer, Brenner, & Bahraini, 2014). Whereas categorical models propose that the development of a condition is a pathological response to extreme stress, dimensional models maintain that stress responses (physical and/or emotional) are “inextricably tied to .…”

“…. the unfolding of biological, psychological, and social processes through time” (Sampson & Laub, 1997, p. 134), and, as such, the development of a disorder (e.g., PTSD, postconcussion syndrome) represents an extreme response to a traumatic event (Bahraini & Brenner, 2013; Nazem et al, 2014).…”

Factitious disorder by proxy, parent alienation, and the argument for interrelated multidimensional diagnoses.

“…The widely discussed issue of categorical and dimensional diagnosis has continued its development as well (e.g., Kraemer, Noda, & O’Hara, 2004) and this discussion is at the core of Bütz et al’s (2009) reconceptualization of FDBP. This debate has received important updates (see Biondi, Gaetano, Pasquini, & Picardi, 2018; Mermis, 2018; Nazem, Spitzer, Brenner, & Bahraini, 2014). Of particular significance are those who have taken the long view regarding the artificial distinction imposed on diagnostic phenomena by categorization at the expense of dimensional considerations in the DSM–5 .…”