We agree that the current emphasis placed on acute dissociative responses is flawed. Recent studies (although not cited by Dr. Marshall et al.) have demonstrated that there are multiple pathways to PTSD and that most trauma survivors who display severe acute stress reactions without dissociation can develop PTSD (3, 4). The assertion by Dr. Marshall et al. that the diagnosis of PTSD should apply immediately after a trauma is problematic because it potentially "pathologizes" transient stress reactions. Discarding the acute stress disorder diagnosis now may also be an overreaction that "throws the baby out with the bath water." Although the available evidence does not support the current criteria for acute stress disorder, prospective studies are beginning to identify constellations of acute symptoms that can predict PTSD with greater accuracy. Rather than prematurely deciding the worth of the acute stress disorder diagnosis at this time, it is important to conduct prospective studies that employ standardized measures that will define the optimal criteria for acute stress disorder and determine whether it deserves to survive in DSM-V.