Authors' reply

Drs de Bruijn & Denys are concerned about identification of PTSD in the absence of the A1 and A2 criteria of the DSM–IV. However, we did not diagnose PTSD but we looked at PTSD symptomatology related to the worst event experienced by participants (including traumatic and non-traumatic events). We did not include the A1 criterion because we wanted to investigate whether the 17 symptoms that are thought to typically occur in those who have experienced a traumatic event, as defined by DSM–IV, are indeed specific for that type of event or occur as frequently following non-traumatic events. In order to study this we inevitably chose events that did not fulfil the A1 criterion (otherwise we would not have had a control group of events). Regarding the A2 criterion, it would be interesting to study respondents’ subjective appraisal of the event in terms of fear, helplessness and horror. This would clarify whether the A2 criterion is also as specific for traumas as is often argued and how it is related to the 17 B criteria of the DSM–IV. We would not be surprised if non-traumatic major events could also evoke the emotions of fear, helplessness and horror.

Drs de Bruijn & Denys were also concerned about the somewhat low specificity of the self-report scale we used to measure PTSD symptoms (the Post-traumatic Stress Symptom Scale – Self-Report version; Foa et al, 1993). However, it is conceivable that our results are owing to the lack of specificity of PTSD symptoms in general for diagnosing PTSD, as was demonstrated in a recent study by Gold et al (2005).

Concerning the results in Table 4: the traumatic events groups did score higher on several items (3 out of 17) but these differences were not significant, indicating that no specific items were more strongly related to traumatic events than to life events.

In summary, our main conclusion that life events can generate as many PTSD symptoms as traumatic events is upheld.