Posttraumatic stress disorder: the missed diagnosis

Abstract

Posttraumatic stress disorder (PTSD) is frequently underdiagnosed in maltreated samples. Protective services information is critical for obtaining complete trauma histories and determining whether to survey PTSD symptoms in maltreated children. In the current study, without protective services information to supplement parent and child report, diagnosing PTSD was missed in a significant proportion of the cases. Collaboration between mental health professionals and protective service workers is critical in determining psychiatric diagnoses and treatment needs of children involved with the child welfare system.

Figure 1. Proportion of traumas reported by each informant

When interviewed, parents and children failed to report approximately half of substantiated incidents of physical and sexual abuse. Mothers were most likely to disclose domestic violence.

Figure 2. Likelihood of Meeting Criteria for PTSD Increases as a Function of the Number of Maltreatment Categories Children Experienced

Children who experienced three or four types of maltreatment experiences were approximately twice as likely as children who only had one or two types of maltreatment experiences to meet diagnostic criteria for PTSD.