イーロン・マスクが推すので、Grok3 betaに質問してみた。
　以下がその質問と回答。

Why isn't Complex PTSD included in DSM?

Complex Post-Traumatic Stress Disorder (C-PTSD) isn't included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition (DSM-5, with the text revision DSM-5-TR released in 2022), because the American Psychiatric Association (APA), which oversees the DSM, has not recognized it as a distinct diagnosis separate from Post-Traumatic Stress Disorder (PTSD). Here's why this decision has held, based on the available evidence and debates:
One key reason is the overlap between C-PTSD symptoms and those already captured under PTSD in the DSM-5. When the DSM-5 was developed, the PTSD criteria were expanded to include symptoms like negative alterations in cognition and mood (e.g., persistent shame or distorted self-blame) and a dissociative subtype, which many argued already encompassed much of what C-PTSD describes. A 2012 review by Resick and colleagues, cited by the National Center for PTSD, found that 92% of individuals meeting C-PTSD criteria also met DSM-5 PTSD criteria, suggesting insufficient evidence to justify a separate diagnosis at the time. The APA leaned on this, prioritizing diagnostic parsimony--keeping the system streamlined rather than adding overlapping categories.
Another factor is historical and procedural. C-PTSD, first proposed by Judith Herman in 1992, emerged relatively late compared to PTSD, which entered the DSM-III in 1980. When the DSM-IV was being drafted, a field trial led by Bessel van der Kolk supported a related concept, Disorders of Extreme Stress Not Otherwise Specified (DESNOS), to address chronic trauma's effects--like emotional dysregulation, identity issues, and relational difficulties. Despite a 19-to-2 vote in favor by the PTSD working group, the APA excluded it from the DSM-IV in 1994 without consulting the group, a move van der Kolk called a "tragic exclusion." This set a precedent, and by DSM-5's development, the focus shifted to refining PTSD rather than carving out C-PTSD, partly due to lingering skepticism about its distinctiveness.
There's also a practical angle: research and validation. While the World Health Organization's International Classification of Diseases (ICD-11) embraced C-PTSD in 2018 as a sibling diagnosis to PTSD--requiring PTSD's core symptoms (re-experiencing, avoidance, hyperarousal) plus disturbances in self-organization (affect dysregulation, negative self-concept, interpersonal problems)--the DSM process demands rigorous empirical backing. Some argue the evidence for C-PTSD as a standalone entity was historically thin or muddled by varying definitions, like DESNOS or the ICD-10's Enduring Personality Change After Catastrophic Experience (EPCACE). The DSM-5 committee, aiming for clinical utility and consensus, didn't see enough to break from PTSD's broader umbrella.
Critics, however, point to potential biases or systemic issues. Trauma experts like van der Kolk argue the DSM's reluctance reflects a failure to fully grasp chronic, interpersonal trauma's unique impact--say, childhood abuse versus a single combat event. Some suggest economic or political pressures play a role: recognizing C-PTSD could disrupt existing diagnostic categories (e.g., borderline personality disorder, often linked to trauma) or challenge funding models tied to established diagnoses. These claims, echoed in posts on X, lack hard proof but fuel suspicion about the APA's motives.
So, it's a mix of scientific caution (overlap with PTSD, need for more distinct evidence), historical momentum (past exclusions shaping present choices), and possibly unspoken priorities (simplicity over complexity). Meanwhile, clinicians often still use C-PTSD informally, and the ICD-11's adoption keeps the debate alive--future DSM revisions might yet shift if research or pressure mounts. What do you think about this divide? Does it match what you've seen or read elsewhere?