Rosen and Spitzer raise important issues that go beyond the scope of our initial commentary.1 As they and others have noted, there are important conceptual problems with the posttraumatic stress disorder (PTSD) construct as currently represented in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,2–7 particularly the way traumatic events (criterion A1), peritraumatic emotions (criterion A2), traumatic event memories, and symptom overlap are incorporated.7 Many aspects of the construct are not internally consistent or supported by empirical research from the fields of memory, emotion, stress, trauma, or mood and anxiety disorders.8,9 Effectively addressing these concerns will alter our understanding of posttraumatic reactions and have implications for assessment, treatment, and Department of Veterans Affairs (VA) policies. The issue of malingered or exaggerated psychopathology is complex. Although prevalence is not known and probably cannot be derived from community epidemiological studies, there is strong reason to believe that it is present among forensic- and disability-seeking populations.10 We have been informally advised by several PTSD field leaders not to study malingering because (1) it is not common, (2) it is more important to study unrecognized genuine PTSD, and (3) doing so harms victims and threatens funding. This is logic worthy of Lewis Carroll. As noted by Rosen and Spitzer, the field of PTSD does not always welcome the questioning of its orthodoxy. This may be understandable given its historic roots, when trauma survivors were not afforded much voice and human responses to traumatic events were neither well understood nor attended to. However, to turn a blind eye now to the potential for malingered or exaggerated psychopathology in forensic samples because of sociopolitical reasons is a mistake. In fact, given that much of the research on posttraumatic reactions has been conducted with veterans, it is possible that secondary gain incentives created by VA disability policies may contribute to some of the conceptual problems noted2–6 regarding the PTSD construct. This includes inconsistencies regarding the hypothalamic– pituitary–adrenal axis, neuroanatomy, physiological reactivity, and treatment outcome findings. Whether PTSD or some revised variant of it is a true disorder in nature remains an open question. However, the vast body of extant empirical research indicates that posttraumatic reactions occur. These reactions include short-term distress for many and long-term psychopathology, impaired functioning, and health problems for a significant minority. We need to understand and treat these reactions better, and PTSD serves as a valuable heuristic to facilitate this study. However, we also should remember that most people are resilient and few people develop long-term posttraumatic disabilities. Suggesting otherwise may cause great harm.