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POSTTRAUMATIC
STRESS DISORDER (PTSD)
AS A DIAGNOTIC
ENTITY
The diagnostic criteria, as listed in
DSM-IV, are:
POSTTRAUMATIC STRESS DISORDER
(from DSM-IV, American Psychiatric Association)
Inclusion: A1
and A2
(A1) The
person has been exposed to a traumatic event in which he/she experienced,
witnessed, or was confronted with an event or events that involved actual or
threatened death or serious injury, or a threat to the physical integrity of
oneself or others.
(A2) The
person's response to the traumatic event involved intense fear, helplessness, or
horror.
Required: at
least 1 from B
(B) The
traumatic event is persistently re-experienced in at
least 1 of the following ways:
(B1)
Recurrent and intrusive distressing recollections of the event, including
images, thoughts, or perceptions.
(B2)
Recurrent distressing dreams of the event.
(B3) Acting
or feeling as if the traumatic event were recurring (includes a sense of
reliving the experience, illusions, hallucinations, and dissociative flashback
episodes, including those that occur on awakening or when intoxicated.
(B4) Intense
psychological distress at exposure to internal or external cues that symbolize
or resemble an aspect of the traumatic event.
(B5)
Physiological reactivity upon exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event.
Required: 3
from C
(C)
Persistent avoidance of stimuli associated with the trauma and numbing of
general responsiveness (not present before the trauma), as indicated by at least
3 of the following:
(C1) Efforts
to avoid thoughts, feelings, or conversations associated with the trauma.
(C2) Efforts
to avoid activities, places, or people that arouse recollections of the trauma.
(C3)
Inability to recall an important aspect of the trauma.
(C4) Markedly
diminished interest or participation in significant activities.
(C5) Feeling
of detachment or estrangement from others.
(C6)
Restricted range of affect (e.g., unable to have loving feelings).
(C7) Sense of
a foreshortened future (e.g., does not expect to have a career, marriage,
children, or a normal life span).
Required: 2
from D
(D)
Persistent symptoms of increased arousal (not present before the trauma), as
indicated by at least 2 of the following:
(D1)
Difficulty falling or staying asleep.
(D2)
Irritability or outbursts of anger.
(D3)
Difficulty concentrating.
(D4)
Hypervigilance.
(D5)
Exaggerated startle response.
Required: E
and F
(E) Duration
of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
(F) The
disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The three clusters of Sx (re-experiencing, numbing/avoidance, and
arousal) that are currently used were derived by clinical observation rather
than research (Foa & Rothbaum, 1998).
RESEARCH
SUGGESTING MODIFICATIONS OF
THE
PTSD DIAGNOSIS IN DSM-IV
Since the publication of the DSM-IV
criteria, empirical research has suggested that the diagnosis may need revisions
for the next DSM, and that some of these revisions could have a substantive
effect on treatment.
Subsequent factor analytic research has found that numbing
and avoidance actually belong to different clusters (Foa et al., 1995).
