Theoretical and empirical foundations of the assessment of post-traumatic stress disorder
The guidelines for the assessment of mental and psychosomatic illnesses (guidelines reports) set out conditions for the recognition of post-traumatic stress disorder. The thesis analyses the theoretical and empirical basis of these conditions. The guidelines reports describe a behaviourist paradigm that aims at external control.
An objective severity of the event or accident and externally visible and documented initial traumatic damage are required. The subjectively perceived danger, on the other hand, is of secondary importance. In the analysis, the assessment of an objective severity of trauma is relativised on the basis of epistemology. Neither experts nor those affected are objective in their perception. Accordingly, the subjective patient perspective should be given a higher priority, as in the guideline for the diagnosis and treatment of acute consequences of psychological trauma.
The studies cited in the guidelines reports do not support the condition of serious injury as a prerequisite for PTSD. Rather, they point out that those affected by moderate injuries (moderate accident severity) can also develop PTSD. A second factor of relevance to PTSD, the resilience and/or vulnerability of the affected persons, is described in the guidelines reports and its inclusion, together with better consideration of subjective perception, may better explain disorders in the case of moderate trauma severity.
Corroboration of documented initial traumatic damage proves to be difficult against the background of demonstrably often incomplete or even incorrect documentation. It is therefore virtually or completely impossible to assert many claims. In the guidelines reports, PTSD and dissociative symptoms tend to be trivialised. The guideline follows the sceptical tradition of moral hazard. However, the unilateral acceptance of conflicts of interest only in the case of patients and not in the case of opponents violates the principle of neutrality.
