I’m reading “What Doesn’t Kill Us“, by Stephen Joseph, mentioned in this earlier post. No mention of over-diagnosis yet. Reader Christy wrote in to say:
Same issue at one of my old jobs. Clinicians diagnosed all the kids with PTSD because they were abused. I remember sitting in group supervision explaining why experiencing trauma does not necessarily mean that one will develop PTSD.
Grieving? Clearly. Traumatized? Possibly. Post-Traumatic Stress Disorder? The odds are 2-to-1 against it.
Unfortunately, I’ve heard similar stories at my community mental-health job. Allen Frances, MD, psychiatrist and chair of the chair of the DSM-IV Task Force, suggests that PTSD is both the most over- and under-diagnosed disorder around.
The Other Side of Sadness is an excellent book on grief and resilience. In it, author George A. Bonanno describes New Yorkers’ surprisingly low rates of post-traumatic symptoms after the 9-11-01 attacks. He writes of how he and the original researchers sifted the data [i] to focus on the people closest to the tragedy – those who witnessed the WTC towers fall with loved ones inside:
“The people who experienced this kind of bereavement had the greatest proportion of severe trauma reactions. Just under one-third met the criteria for PTSD. That is about the highest proportion of PTSD that any event will produce. And yet just as many people who had experienced this same horror — one in three — had no trauma reaction at all.”
Exposure to trauma is not the same as post-traumatic symptoms. Post-traumatic symptoms are not the same as Post-Traumatic Stress Disorder. These days, there’s a lot of heat on the American Psychiatric Association over the upcoming DSM-5. Evolving criteria for diagnosing mental illness is a much less serious threat to accuracy than those who don’t or won’t take the time to use the DSM properly.
@ 2012 Jonathan Miller All Rights Reserved
[i] Bonanno, G.A., Sandro Galea, A. Bucciarelli, and D. Vlahov. 2006. “Psychological Resilience after Disaster – New York City in the Aftermath of the September 11th Terrorist Attack.” Psychological Science, 17(3): 181-186.
PsychotherapySphere 
I agree with your post and I also believe that it can be underdiagnosed in some circles as well. I find that former criminals (drug dealers and gang bangers) show more symptoms of PTSD, much like that of a soldier who has seen combat. However, they are often given diagnoses of schizo-affective or psychotic disorder nos. This may be part the clinician, but also a fear of the client to be totally open about their experiences with their clinician. What they need to share often involves illegal activity, so they re guarded for fear of legal implications…. just a thought…