PTSD,DSMIV Criteria

<h3>[<a title="Edit section: DSM-IV criteria" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=13">edit</a>] DSM-IV criteria</h3>

<p>The diagnostic criteria for PTSD, stipulated in the <i><a title="Diagnostic and Statistical Manual of Mental Disorders" href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders">Diagnostic and Statistical Manual of Mental Disorders</a> IV (Text Revision)</i> (DSM-IV-TR), may be summarized as:<sup id="cite_ref-DSM4_2-6" class="reference"><a href="#cite_note-DSM4-2">[1]</a></sup><sup id="cite_ref-80" class="reference"><a href="#cite_note-80">[79]</a></sup></p>

<h4>[<a title="Edit section: A: Exposure to a traumatic event" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=14">edit</a>] A: Exposure to a traumatic event</h4>

<p>This must have involved <i>both</i> (a) loss of "physical integrity", or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror, or helplessness (or in children, the response must involve disorganized or agitated behavior). (The <a class="mw-redirect" title="DSM-IV" href="/wiki/DSM-IV">DSM-IV</a>-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience."<sup id="cite_ref-81" class="reference"><a href="#cite_note-81">[80]</a></sup>)</p>

<h4>[<a title="Edit section: B: Persistent re-experiencing" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=15">edit</a>] B: Persistent re-experiencing</h4>

<p>One or more of these must be present in the victim: <a class="mw-redirect" title="Flashback (psychological phenomenon)" href="/wiki/Flashback_(psychological_phenomenon)">flashback</a> memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).</p>

<h4>[<a title="Edit section: C: Persistent avoidance and emotional numbing" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=16">edit</a>] C: Persistent avoidance and emotional numbing</h4>

<p>This involves a sufficient level of:</p>

<ul>

<li>avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s);</li>

<li>avoidance of behaviors, places, or people that might lead to distressing memories as well as the disturbing memories, dreams, flashbacks, and intense psychological or physiological distress;<sup id="cite_ref-Olszewski_2005_40_20-4" class="reference"><a href="#cite_note-Olszewski_2005_40-20">[19]</a></sup></li>

<li>inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;</li>

<li>decreased capacity (down to complete inability) to feel certain feelings;</li>

<li>an expectation that one's future will be somehow constrained in ways not normal to other people.</li>

</ul>

<h4>[<a title="Edit section: D: Persistent symptoms of increased arousal not present before" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=17">edit</a>] D: Persistent symptoms of increased arousal not present before</h4>

<p>These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or <a title="Hypervigilance" href="/wiki/Hypervigilance">hypervigilance</a>. Additional symptoms include irritability, angry outbursts, increased startle response, and concentration or sleep problems.<sup id="cite_ref-Olszewski_2005_40_20-5" class="reference"><a href="#cite_note-Olszewski_2005_40-20">[19]</a></sup></p>

<h4>[<a title="Edit section: E: Duration of symptoms for more than 1 month" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=18">edit</a>] E: Duration of symptoms for more than 1 month</h4>

<p>If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with <a class="mw-redirect" title="Acute stress disorder" href="/wiki/Acute_stress_disorder">Acute stress disorder</a>.<sup id="cite_ref-Olszewski_2005_40_20-6" class="reference"><a href="#cite_note-Olszewski_2005_40-20">[19]</a></sup></p>

<h4>[<a title="Edit section: F: Significant impairment" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=19">edit</a>] F: Significant impairment</h4>

<p>The symptoms reported must lead to "clinically significant distress or impairment" of major domains of life activity, such as social relations, occupational activities, or other "important areas of functioning".<sup id="cite_ref-82" class="reference"><a href="#cite_note-82">[81]</a></sup></p>

<h4>[<a title="Edit section: Assessment" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=20">edit</a>] Assessment</h4>

<p>Since the introduction of <a class="mw-redirect" title="DSM-IV" href="/wiki/DSM-IV">DSM-IV</a>, the number of possible events which might be used to diagnose PTSD has increased; one study suggests that the increase is around 50%.<sup id="cite_ref-Breslau_83-0" class="reference"><a href="#cite_note-Breslau-83">[82]</a></sup> Various scales exist to measure the severity and frequency of PTSD symptoms.<sup id="cite_ref-84" class="reference"><a href="#cite_note-84">[83]</a></sup><sup id="cite_ref-85" class="reference"><a href="#cite_note-85">[84]</a></sup> Standardized screening tools such as <a title="Trauma Screening Questionnaire" href="/wiki/Trauma_Screening_Questionnaire">Trauma Screening Questionnaire</a><sup id="cite_ref-86" class="reference"><a href="#cite_note-86">[85]</a></sup> and <a title="PTSD Symptom Scale – Self-Report Version" href="/wiki/PTSD_Symptom_Scale_%E2%80%93_Self-Report_Version">PTSD Symptom Scale</a><sup id="cite_ref-87" class="reference"><a href="#cite_note-87">[86]</a></sup> can be used to detect possible symptoms of posttraumatic stress disorder and suggest the need for a formal diagnostic assessment.</p>

<h3>[<a title="Edit section: Research-based alternative symptom groups" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=21">edit</a>] Research-based alternative symptom groups</h3>

<p>Emerging <a title="Factor analysis" href="/wiki/Factor_analysis">factor analytic</a> research<sup id="cite_ref-Pietrzak_88-0" class="reference"><a href="#cite_note-Pietrzak-88">[87]</a></sup> suggests that PTSD symptoms group empirically into four clusters, not the three currently described in the <i><a title="Diagnostic and Statistical Manual of Mental Disorders" href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders">Diagnostic and Statistical Manual of Mental Disorders</a></i>. One model supported by this research divides the traditional avoidance symptoms into a cluster of numbing symptoms (such as loss of interest and feeling emotionally numb) and a cluster of behavioral avoidance symptoms (such as avoiding reminders of the trauma).<sup id="cite_ref-89" class="reference"><a href="#cite_note-89">[88]</a></sup> An alternative model adds a fourth cluster of dysphoric symptoms. These include symptoms of emotional numbing, as well as anger, sleep disturbance, and difficulty concentrating (traditionally grouped under the hyperarousal cluster).<sup id="cite_ref-90" class="reference"><a href="#cite_note-90">[89]</a></sup><sup id="cite_ref-91" class="reference"><a href="#cite_note-91">[90]</a></sup> A literature review<sup id="cite_ref-92" class="reference"><a href="#cite_note-92">[91]</a></sup> and meta-analysis<sup id="cite_ref-93" class="reference"><a href="#cite_note-93">[92]</a></sup> did not find strong support across the literature for one of these models over the other.</p>

<h3>[<a title="Edit section: DSM-5 proposed diagnostic criteria changes" href="/w/index.php?title=Posttraumatic_stress_disorder&action=edit&section=22">edit</a>] DSM-5 proposed diagnostic criteria changes</h3>

<p>In preparation for the May 2013<sup id="cite_ref-94" class="reference"><a href="#cite_note-94">[93]</a></sup> release of the <a title="DSM-5" href="/wiki/DSM-5">DSM-5</a>,<sup id="cite_ref-95" class="reference"><a href="#cite_note-95">[94]</a></sup> the fifth version of the <a title="American Psychiatric Association" href="/wiki/American_Psychiatric_Association">American Psychiatric Association</a>'s diagnostic manual, draft diagnostic criteria were released for public comment, followed by a two-year period of field testing.<sup id="cite_ref-96" class="reference"><a href="#cite_note-96">[95]</a></sup> Proposed changes to the criteria (subject to ongoing review<sup id="cite_ref-97" class="reference"><a href="#cite_note-97">[96]</a></sup> and research<sup id="cite_ref-98" class="reference"><a href="#cite_note-98">[97]</a></sup>) include the following:<sup id="cite_ref-99" class="reference"><a href="#cite_note-99">[98]</a></sup></p>

<ul>

<li>Criterion A (prior exposure to traumatic events) is more specifically stated, and evaluation of an individual's emotional response at the time (current criterion A2) is dropped.</li>

<li>Several items in Criterion B (intrusion symptoms) are rewritten to add or augment certain distinctions now considered important.</li>

<li>Special consideration is given to developmentally appropriate criteria for use with children and adolescents. This is especially evident in the restated Criterion B—intrusion symptoms. Development of age-specific criteria for diagnosis of PTSD is ongoing at this time.</li>

<li>Criterion C (avoidance and numbing) has been split into "C" and "D":

<ul>

<li>Criterion C (new version) now focuses solely on avoidance of behaviors or physical or temporal reminders of the traumatic experience(s). What were formerly two symptoms are now three, due to slight changes in descriptions.</li>

<li>New Criterion D focuses on negative alterations in cognition and mood associated with the traumatic event(s) and contains two new symptoms, one expanded symptom, and four largely unchanged symptoms specified in the previous criteria.</li>

</ul>

</li>

<li>Criterion E (formerly "D"), which focuses on increased arousal and reactivity, contains one modestly revised, one entirely new, and four unchanged symptoms.</li>

<li>Criterion F (formerly "E") still requires duration of symptoms to have been at least one month.</li>

<li>Criterion G (formerly "F") stipulates symptom impact ("disturbance") in the same way as before.</li>

<li>The "acute" vs "delayed" distinction is dropped; the "delayed" specifier is considered appropriate if clinical symptom onset is no sooner than 6 months after the traumatic event(s).</li>

</ul>

<p>"Developmental trauma disorder", a proposed new diagnosis, was still under discussion at the time of the draft publication.<sup id="cite_ref-100" class="reference"><a href="#cite_note-100">[99]</a></sup>

The name of the disorder is being reviewed for a possible change, to <b>posttraumatic stress injury</b>, ostensibly to help reduce stigma towards those afflicted.<sup id="cite_ref-101" class="reference"><a href="#cite_note-101">[100]</a></sup></p>