Posttraumatic stress disorder caused by hallucinations and delusions experienced in delirium.

In the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM–IV), the definition of posttraumatic stress disorder (PTSD) requires that the individual “experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others (DSM–IV, 1994).” This definition assumes that the events were real, with one of the cardinal symptoms of the diagnosis being that the individual persistently reexperiences this real event. The life-threatening nature of organ transplantation can undoubtedly create the physical and emotional circumstances for the development of PTSD. Transplant patients are only too aware of the seriousness of their condition, and they frequently experience medical complications, including episodes of delirium preand postoperatively. We present four cases of transplant patients who, while in delirium, experienced delusions and hallucinations of life-threatening events that were later reexperienced as clinically diagnosed PTSD. These cases demonstrate that not only real life-threatening medical events, but delirium experiences that occur during a lifethreatening medical crisis or illness, can provoke PTSD. Therefore, an extension of the PTSD criteria to include both real and psychically-induced experiences seems warranted. Background information about each case has been slightly modified to protect patients’ confidentiality.