To the Editor: In their recent article, Randall D. Marshall, M.D., et al. (1) raised important considerations regarding the diagnosis of acute stress disorder. This was a much-needed analysis; however, I have reached different conclusions with respect to the importance of including dissociative symptoms in the acute stress disorder diagnosis. Dr. Marshall et al. interpreted their inconsistent findings regarding the ability of peritraumatic dissociative symptoms to predict later posttraumatic stress disorder (PTSD) to indicate that dissociative symptoms should not be required in the diagnosis of acute stress reactions to a traumatic life event. I have two major concerns with this argument, although there may be a common ground, suggested by the analysis by Dr. Marshall et al., on which to resolve this debate.