Diagnostic Musings on Tribulations of the COVID-19 Pandemic: “TPSD” and PTSD

A made-up diagnosis of “TPSD,” or “toilet paper stress disorder,” illustrates inherent features of current definitions of trauma and stress for the diagnosis of posttraumatic stress disorder (PTSD) in current American diagnostic criteria for psychiatric disorders. Special emphasis is given to application of these concepts to the 2019 coronavirus (COVID-19) pandemic. This article emphasizes the differentiation of trauma from other stress in the diagnostic criteria for PTSD. It further explains that the current criteria do not include naturally-occurring non-emergency medical illness as trauma, which would exclude naturally occurring viral infections, whether occurring sporadically or as part of a situation formally declared to be a major disaster, such as the COVID-19 pandemic. “Product champions” for the PTSD diagnosis, enthusiastic proponents of unrestrained use of the PTSD label for anyone experiencing adversity or psychiatric symptoms and needing psychiatric treatment, have pushed for the expansion of the diagnostic criteria and for more widespread application of the diagnosis of PTSD, an occurrence also known as “bracket creep.” Research needed to validate the diagnostic criteria for PTSD and categorize syndromes following stressors not currently defined as traumatic is outlined in this article with specific methodological recommendations to inform decisions about changes to diagnostic criteria.