PTSD in DSM-5: Changes and Criteria for Posttraumatic Stress Disorder, Schemes and Mind Maps of Medicine

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Trauma and Stress-Related

Disorders in DSM-

Matthew J. Friedman MD, PhD

National Center for PTSD

Geisel School of Medicine at

Dartmouth

Disclosures

Sources of Research Support

1. U.S. Department of Veterans Affairs
2. U.S. Department of Defense

Paid Editorial Relationship None Consulting Relationship PRN Stock Equity (>$10,000) None

Speaker’s Bureau None

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders , (5th ed.). Washington, DC: Author.

DSM-5: Metastructure

• Neurodevelopmental Disorders
• Schizophrenia Spectrum & Other Psychotic Disorders
• Bipolar & Related Disorders
• Depressive disorders
• Anxiety Disorders
• Obsessive-Compulsive, Stereotypic & Related Disorders
• Trauma- and Stressor-Related Disorders
• Dissociative Disorders
• Somatic Symptom Disorders etc.

DSM-IV Anxiety Disorders in DSM-

• Anxiety Disorders

Panic, Specific Phobia, Social Phobia, GAD etc.

• O-C, Stereotypic & Related Disorders

OCD, Body Dysmorphic, Hoarding, Hair Pulling, Skin Picking, etc.

• Trauma- and Stressor-Related Disorders

PTSD, ASD, ADs, Reactive Attachment Disorder, etc.

• Dissociative Disorders

DID, Depersonalization/Derealization, Dissociative Amnesia, etc.

DSM-5: Changes to PTSD Criteria

• Criterion A2 (response involves “fear, helplessness,

or horror”) removed from DSM-

• 3 clusters are divided into 4 clusters in DSM-
• 3 new symptoms were added
• Other symptoms revised to clarify symptom

expression

• All symptoms began or worsened after the trauma
• Separate diagnostic criteria for “preschool” (children

6 years or younger)

• New dissociative subtype for PTSD added

DSM-5: PTSD Criterion A

A. The person was exposed to: death,

threatened death, actual or threatened

serious injury, or actual or threatened

sexual violence, as follows:

1. Direct exposure
2. Witnessing, in person

Criterion A continues on next slide.

.

PTSD Criteria for DSM-

B. Intrusion symptoms

C. Persistent avoidance of stimuli associated

with the trauma

D. Negative alterations in cognitions and mood

that are associated with the traumatic event

E. Alterations in arousal and reactivity that are

associated with the traumatic event

DSM-5: PTSD Criterion B

B. Intrusion (1/5 symptoms needed)

1. Recurrent, involuntary and intrusive recollections *
   • children may express this symptom in repetitive play
2. Traumatic nightmares *
   • children may have disturbing dreams without content related to trauma

Criterion B continues on next slide.

DSM-5: PTSD Criterion C

C. Persistent effortful avoidance of distressing

trauma-related stimuli after the event (1/

symptoms needed):

1. Trauma-related thoughts or feelings
2. Trauma-related external reminders (e.g. people, places, conversations, activities, objects or situations)

DSM-5: PTSD Criterion D

D. Negative alterations in cognitions and

mood that began or worsened after the

traumatic event (2/7 symptoms needed)

1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs) (C3 in DSM-IV )

Criterion D continues on next slide.

DSM-5: PTSD Criterion D

Criterion D ( continued ):

4. Persistent negative trauma-related emotions (e.g. fear, horror, anger, guilt, or shame) (new)
5. Markedly diminished interest in (pre-traumatic) significant activities (C4 in DSM-IV )
6. Feeling alienated from others (e.g. detachment or estrangement) (C5 in DSM-IV )
7. Constricted affect: persistent inability to experience positive emotions (C6 in DSM-IV )

DSM-5: PTSD Criterion E

E. Trauma-related alterations in arousal and

reactivity that began or worsened after the

traumatic event (2/6 symptoms needed)

1. Irritable or aggressive behavior (revised D2 in DSM-IV )
2. Self-destructive or reckless behavior (new)

Criterion E continues on next slide.

PTSD Criteria for DSM-

F. Persistence of symptoms (in Criteria B, C, D

and E) for more than one month

G. Significant symptom-related distress or

functional impairment

H. Not due to medication, substance or illness

Preschool Subtype: 6 Years or Younger

Relative to broader diagnosis for adults (or those

over 6 years):

• Criterion B – no change (1 Sx needed)

• 1 Sx from EITHER Criterion C or D

• C cluster – no change (2 Avoidance Sx)
• D cluster – 4/7 adult Sx  Preschool does not include: amnesia; foreshortened future; persistent blame of self or others

• Criterion E – 5/6 adult Sx (2 Sx needed)

 Preschool does not include reckless behavior