A 35-year-old combat veteran reports recurrent intrusive memories, flashbacks of battle scenes, emotional numbing, and hypervigilance for 7 months. He avoids any reminders of war. He also meets full criteria for major depressive disorder. The correct diagnostic approach per DSM-5 is:

• A Diagnose PTSD only; depressive symptoms are subsumed under 'negative alterations in cognition and mood' criterion
• B Diagnose major depressive disorder only; PTSD is secondary
• C Diagnose adjustment disorder with depressed mood since trauma exposure is the precipitant
• D Both PTSD and major depressive disorder can be co-diagnosed simultaneously; they are distinct diagnoses with separate treatment implications ✓

Explanation

DSM-5 explicitly allows PTSD and major depressive disorder to be co-diagnosed as comorbid conditions, since their diagnostic criteria are distinct even though they share some symptoms (anhedonia, sleep disturbance). The 'negative alterations in cognition and mood' PTSD criterion does not preclude a concurrent MDD diagnosis. This distinction matters therapeutically: SSRIs (sertraline, paroxetine — FDA-approved for PTSD) address both, while trauma-focused psychotherapy (Prolonged Exposure, CPT) is also indicated. Adjustment disorder cannot be diagnosed when PTSD criteria are met.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.