We welcome the responses by Cantor and Nielssen & Large to our editorial. On the lighter side, we observe that yet more proposals for post-traumatic conditions are proposed by Cantor (e.g. PSRHD), thereby demonstrating an ever increasing incidence of ‘acronymitis’. This disorder, characterised by a seeming compulsion to develop acronyms, was to the best of our knowledge first labeled by Isaac Marks (personal communication, 2005).

On a more serious note, we would like to use our limited space to highlight several observations that we have taken from an extensive review of the PTSD construct. ^{Reference Rosen and Lilienfeld1} This review proposes that PTSD's defined clinical syndrome might best be conceptualised as encompassing a broad range of reactions to adverse events that are in turn influenced by multiple dimensionally distributed factors (e.g. pre- and post-incident risk variables, peri-traumatic appraisals and real-life consequences). The long history of general stress studies, and more recent research on PTSD, has demonstrated that these multiple factors and their complex interrelations yield a wide range of outcomes after adverse events. Within this framework, it remains an open question whether any attempt to define a distinct post-traumatic syndrome can lead to a true disorder in nature that is specific to a subset of stressors. Perhaps such a disorder exists, and PTSD or some other acronym should remain in the psychiatric nomenclature. For the moment, however, it appears that the very literature spurred by the creation of PTSD has demonstrated, somewhat ironically, that the construct is flawed. It is in the context of these concerns that we acknowledge issues raised in the Journal's letters and encourage continued discussion on the validity of the PTSD diagnosis.