Staff Perspective: A Comparison of the Changes to the PTSD Diagnosis in DSM V

Staff Perspective: A Comparison of the Changes to the PTSD Diagnosis in DSM V

Last summer my colleague Holly O’Reilly filled you in on some of the changes to the PTSD diagnosis with the publication of DSM-5.  After reviewing the changes side-by-side, I thought it might be helpful to share this table with you detailing the differences, so you could look at the key changes in context and get a handle on what is different and what has stayed the same.

What follows is a brief description of the criteria in the right hand column and a summary of the key changes from DSM-IV to DSM-5 in the left hand column. New symptoms are highlighted in red text. For the full text and additional information please refer to the DSM-5.

The PTSD Diagnosis in DSM-5

Revised Criterion A

A)  The Stressor

  1. Exposed to actual or threatened, death, serious injury, sexual violence
  2. Directly
  3. Witnessing in person
  4. Indirectly re: a close relative or friend (must be violent or accidental)
  5. Repeated indirect exposure to aversive details

NOTE: Does not apply to media exposure unless it is work related.

  • Sexual violation is spelled out specifically
  • Clarifies indirect exposure in two ways
  • Criterion A2 is dropped (fear, horror, helplessness)

 

Revised symptoms clusters B-E (now 4 instead of 3)

B)  Intrusion (need 1)

  1. Involuntary, intrusive recollections of the traumatic event
  2. Traumatic nightmares related to the event
  3. Dissociative reactions/flashbacks (specifies this is a continuum)
  4. Intense or prolonged distress after reminders
  5. Physiological reactivity after exposure to T. related stimuli

Item content is the same but has been revised to:

  • Excludes depressive rumination
  • Broaden the definition of nightmares
  • Define flashbacks as a dissociative symptom, and part of a continuum of dissociative reactions that may occur

C)  Avoidance (need 1)

  1. Memories, thoughts or feelings of the trauma
  2. External reminders of the trauma (people, places, activities objects, situations, places)

Separates out numbing symptoms from DSM-IV symptoms and places them under the next category

D)  Negative Alterations in Cognitions and Mood (need 2)

  1. Inability to recall key features
  2. Persistent distorted negative beliefs about self, others and world
  3. Persistent, distorted blame of self or others (new)
  4. Persistent negative trauma related emotions (new)
  5. Markedly diminished interest in significant activities
  6. Feeling alienated from others
  7. Constricted affect

Includes the five numbing symptoms from DSM-IV plus two new ones reframed as cognitive/affective symptoms

  • Specifies memory loss not due to drugs, alcohol or head injury
  • Foreshortened future is reconceptualized to include negative beliefs about self, others and world
  • Constricted affect is specified as inability to experience positive emotions
  • Two new symptoms address negatively distorted cognitions and negative emotional states

E)  Trauma related alterations in arousal and reactivity (need 2)

  1. Irritable or aggressive behavior
  2. Self-destructive or reckless behavior (new)
  3. Hypervigilence
  4. Exaggerated startle response
  5. Problems in concentration
  6. Sleep disturbance
  • Specifies behavioral expression rather than feelings
  • Adds one new symptom

 

F)   Persistence > 1 month

 

G)  Significant distress or functional impairment

 

H)  Not due to meds, substances or illness

 

  • Specifiers

Specify if: With dissociative symptoms

If, in addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

  • Depersonalization: experience of being an outside observer of, or detached from, oneself
  • Derealization: experience of unreality, distance, or distortion

Note: Not attributable to the physiological effects of substance use or medical conditions.

  • Dissociative subtype added
  • Preschooler subtype specified separately
  • No distinction between acute and chronic

Specify if: With delayed expression.

Full diagnosis is not met until at least six months after the trauma(s), though onset may occur immediately.

 

I have also gotten a look at the revised Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013), and the PTSD Checklist for DSM-5 (PCL-V; Weathers et al., 2013), both of which can be obtained by filling out a request form on the NCPTSD webpage. We should have a direct download of these soon on our site here, so stay tuned. 

Dr. Kelly Chrestman is the Lead for Online Consultation Services at the Center for Deployment Psychology.