DSM-IV-TR (2000) diagnostic criteria for Posttraumatic Stress Disorder (PTSD)

The following are the DSM-IV-TR (2000) diagnostic criteria for Posttraumatic Stress Disorder (PTSD):
A. The person has been exposed to a traumatic event in which both of the following were present:
o (1) The person 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 self or others.
o (2) The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
o (3) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
o (4) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
o (5) 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). Note: In young children, trauma-specific reenactment may occur.
o (6) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
o (7) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
o (8) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
o (9) Efforts to avoid activities, places, or people that arouse recollections of the trauma
o (10) Inability to recall an important aspect of the trauma
o (11) Markedly diminished interest or participation in significant activities
o (12) Feeling of detachment or estrangement from others
o (13) Restricted range of affect (e.g., unable to have loving feelings)
o (14) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal lifespan)
D. D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
o (1) Difficulty falling or staying asleep
o (2) Irritability or outbursts of anger
o (3) Difficulty concentrating
o (4) Hypervigilance
o (5) Exaggerated startle response
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.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.
Now, the following are the DSM-5 (2013) diagnostic criteria for Posttraumatic Stress Disorder (PTSD) in adults:
Criterion A: stressor
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required)
1. Direct exposure.
2. Witnessing, in person.
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.
Criterion B: intrusion symptoms
The traumatic event is persistently re-experienced in the following way(s): (1 required)
1. Recurrent, involuntary, and intrusive memories. Note: Children older than 6 may express this symptom in repetitive play.
2. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
4. Intense or prolonged distress after exposure to traumatic reminders.
5. Marked physiologic reactivity after exposure to trauma-related stimuli.
Criterion C: avoidance
Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required)
1. Trauma-related thoughts or feelings.
2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
Criterion D: negative alterations in cognitions and mood
Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required)
1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs).
2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous.").
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame).
5. Markedly diminished interest in (pre-traumatic) significant activities.
6. Feeling alienated from others (e.g., detachment or estrangement).
7. Constricted affect: persistent inability to experience positive emotions.
Criterion E: alterations in arousal and reactivity
Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required)
1. Irritable or aggressive behavior.
2. Self-destructive or reckless behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems in concentration.
6. Sleep disturbance.
Criterion F: duration
Persistence of symptoms (in Criteria B, C, D and E) for more than one month.
Criterion G: functional significance
Significant symptom-related distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion
Disturbance is not due to medication, substance use, or other illness.
Specify if: With dissociative symptoms.
In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").
Specify if: With delayed expression.
Full diagnosis is not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately.
Based upon your readings of trauma-related inventories this week, and your review of the diagnostic criteria of PTSD above, compare and contrast the DSM-IV-TR and DSM-5 diagnostic criteria. Based on the similarities and differences, what features of PTSD would you want to include in an updated measure? What specific questions would you suggest for inclusion in such a measure? What questions would you consider when designing them for a scale for detecting unusual symptoms or malingered trauma symptoms? Be as specific as possible.
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