0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
CLINICAL SYNTHESIS   |    
Highlights of Changes from DSM-IV to DSM-5: Posttraumatic Stress Disorder
American Psychiatric Association Division of Research
FOCUS 2013;11:358-361. doi:10.1176/appi.focus.11.3.358
text A A A

Posttraumatic stress disorder (PTSD) is now in a separate chapter in DSM-5 on Trauma- and Stressor-Related Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among several changes approved for this condition that is increasingly at the center of public as well as professional discussion.

The diagnostic criteria for DSM-5 (Table 1) identifies the trigger to PTSD as exposure to actual or threatened death, serious injury, or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:

Anchor for Jump
Table 1.DSM-5 Criteria for Posttraumatic Stress Disordera
Table Footer Note

a The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see Table 2. Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Washington, DC, APA 2013. Copyright © 2013, American Psychiatric Association. Used with permission.

  • directly experiences the traumatic event;

  • witnesses the traumatic event in person;

  • learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or

  • experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).

The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual’s social interactions, capacity to work, or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs, or alcohol.

Compared with DSM-IV, the diagnostic criteria for DSM-5 draw a clearer line when detailing what constitutes a traumatic event. Sexual assault is specifically included, for example, as is a recurring exposure that could apply to police officers or first responders. Language stipulating an individual’s response to the event—intense fear, helplessness, or horror, according to DSM-IV—has been deleted because that criterion proved to have no utility in predicting the onset of PTSD.

DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and includes four distinct diagnostic clusters instead of three. They are described as re-experiencing, avoidance, negative cognitions and mood, and arousal.

Re-experiencing covers spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks, or other intense or prolonged psychological distress. Avoidance refers to distressing memories, thoughts, feelings, or external reminders of the event.

Negative cognitions and mood represents myriad feelings, from a persistent and distorted sense of blame of self or others, to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event.

Finally, arousal is marked by aggressive, reckless, or self-destructive behavior, sleep disturbances, hypervigilance, or related problems. The current manual emphasizes the “flight” aspect associated with PTSD; the criteria of DSM-5 also account for the “fight” reaction often seen.

The number of symptoms that must be identified depends on the cluster. DSM-5 only requires that a disturbance continue for more than a month and eliminates the distinction between acute and chronic phases of PTSD.

DSM-5 also includes two key additions to PTSD criteria: a separate criteria set for PTSD in children younger than 6 years (Table 2) and a subtype of PTSD with prominent dissociative symptoms (either experiences of feeling detached from one’s own mind or body, or experiences in which the world seems unreal, dreamlike, or distorted).

Anchor for Jump
Table 2.DSM-5 Criteria for Posttraumatic Stress Disorder for Children 6 Years and Youngera
Table Footer Note

a Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Washington, DC, APA 2013. Copyright © 2013, American Psychiatric Association. Used with permission.

Anchor for Jump
Table 1.DSM-5 Criteria for Posttraumatic Stress Disordera
Table Footer Note

a The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see Table 2. Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Washington, DC, APA 2013. Copyright © 2013, American Psychiatric Association. Used with permission.

Anchor for Jump
Table 2.DSM-5 Criteria for Posttraumatic Stress Disorder for Children 6 Years and Youngera
Table Footer Note

a Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Washington, DC, APA 2013. Copyright © 2013, American Psychiatric Association. Used with permission.

+

References

+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
DSM-5™ Clinical Cases > Chapter 2.  >
DSM-5™ Clinical Cases > Chapter 7.  >
DSM-5™ Clinical Cases > Chapter 16.  >
DSM-5™ Clinical Cases > Chapter 7.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles