Sunday, April 14, 2013

PTSD in the DSM-5 - Review of Changes

Now that the DSM-5 revision is completed and going to press, we can begin to assess some of the changes. For me, one of the major areas of interest is the PTSD diagnosis.

It seems a good move to take it out of the anxiety category and place it in a new category of Trauma- and Stress-or-Related Disorders. There are also four symptom clusters now, with the addition of negative cognitions and mood: Re-experiencing, Avoidance, Negative cognitions and mood, and Arousal.

Another important change is to include two subtytpesPreschool’ for children younger than 6 years, and ‘Dissociative’ for people with prominent dissociative symptoms.

Here is the full summary from Trauma Recovery.

PTSD in the DSM-5

Posted on 11 April 2013

What is going to change in the criteria for a PTSD diagnosis in the 5th edition of the psychiatry ‘bible’, the Diagnostic and Statistical Manual of Mental Disorders?

The DSM-5 is to be published in May this year but some information on the changes starts to trickle through…

Below are the most important changes, drawn from a handout of the American Psychiatric Association:

1. PTSD will no longer be classified as an anxiety disorder. It will fall under the new ‘Trauma- and Stress-or-Related Disorders’.

2. The definition of trauma exposure will change: it no longer requires someone to respond with fear, helplessness or horror to the event. The exposure to actual or threatened death, serious injury or sexual violation will be central to the definition, with media exposure being explicitly excluded unless it is work-related.

3. There will be four instead of three symptom clusters:
  • Re-experiencing
  • Avoidance
  • Negative cognitions and mood
  • Arousal
The new cluster of negative cognitions and mood includes estrangement from others, a persistent and distorted sense of blame of self/others, diminished interest in activities and inability to remember key aspects of the event. The arousal cluster will include more aggression-related symptoms than it did in the DSM-IV.

4. There will be two subtypes: ‘Preschool’ for children younger than 6 years, and ‘Dissociative’ for people with prominent dissociative symptoms.

What do you think of these changes? Do they align with your experience? And if you work with the DSM, will you start applying the DSM-5 criteria right away or do you expect to stick with the DSM-IV criteria for a while?
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