Dsm 5 Criteria For Ptsd Diagnosis

Factor Structure Of Ptsd Among Conflict

Validation of the symptom structure of PTSD across non-western populations is a necessary prerequisite to establishing a culturally robust model for understanding traumatic stress . Yet, to date, research on PTSD, has overwhelmingly relied on western samples . While this represents a useful starting point for understanding traumatic stress, it is important that further research captures the diversity of traumatic experiences that occur globally. In particular, refugee populations are exposed to a wide variety of traumatic events that are distinct from western experiences of trauma. For instance, refugees often report multiple, prolonged and severe traumatisation, including torture, political persecution, and traumatic bereavement . Another distinguishing feature of resettled refugee populations is their experience of post-migratory stress, which has been shown to strongly influence symptoms of traumatic stress . Accordingly, experiences of persecution and displacement are characteristic of refugee populations and stand in contrast to traumatic experiences commonly studied in western populations. As such, understanding the core ways that experiences of persecution and displacement influence the symptom structure of PTSD is uniquely valuable in advancing our conceptualisation of PTSD in refugees and asylum-seekers and assisting a population in great need of treatment interventions.

What Is A Diagnosis

A diagnosis is a formal label that describes a certain set of problems or symptoms. Official diagnostic criteria describe which symptoms are necessary for any particular diagnosis. A diagnosis should help the person experiencing symptoms and should always be used in the context of a wider understanding of the persons needs, challenges and strengths when developing care plans. In mental health, diagnoses often describe a group of shared thoughts, behaviours and symptoms. Identifying these groupings helps professionals communicate effectively and, more importantly, supports research to identify what works to help people experiencing difficulties.

In some cases, a persons particular profile of difficulties may not meet the threshold for a diagnosis, but they can still be very distressing and warrant treatment.

There are two similar but not identical, recognised sets of diagnostic criteria for mental health problems:

• The International Classification of Diseases 11th Revision produced by the World Health Organisation .
• The Diagnostic and Statistical Manual 5th Edition produced by the American Psychiatric Association .

People find different kinds of meaning in diagnosis. For some people it helps them explain or make sense of the experiences they have had and the impact it has had on their lives. For others it may feel stigmatising, reductive, meaningless or result in them feeling like they are being treated as a set of symptoms rather than a person.

Changes Between The Dsm

• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
• erroneous self-blame or blaming others for the trauma
• negative mood states
• reckless and maladaptive behavior, e.g. example reckless driving
• the irritability symptoms has criterion been changed to aggressive behavior, which includes verbal aggression but does not refer to violence :272-274
• illusions and hallucinations have been removed from the examples of trauma symptoms listed in one criteria
• the DSM-IV delayed onset specifier has been reworded to delayed expression this is used when symptoms were delayed for at least 6 months after the trauma. Some PTSD symptoms may begin immediately after the trauma. :273-274

A sense of a foreshortened future,PTSD dissociative sub-typespecifier

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Diagnostic Classification Of Ptsd

Perhaps the most substantial conceptual change in the DSM-5 for PTSD was the removal of the disorder from the anxiety disorders category. Considerable research has demonstrated that PTSD entails multiple emotions outside of the fear/anxiety spectrum , thus providing evidence inconsistent with inclusion of PTSD with the anxiety disorders. In the DSM-5, PTSD was placed in a new diagnostic category named Trauma and Stressor-related Disorders indicating a common focus of the disorders in it as relating to adverse events. This diagnostic category is distinctive among psychiatric disorders in the requirement of exposure to a stressful event as a precondition. Other disorders included in this diagnostic category are adjustment disorder, reactive attachment disorder, disinhibited social engagement disorder, and acute stress disorder. This is the only diagnostic category in the DSM-5 that is not grouped conceptually by the types of symptoms characteristic of the disorders in it.

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What Is The Dsm

Used to diagnose mental disorders, DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It’s a book that is basically like an encyclopedia of psychological disorders. The book originally was published in 1952, but has been updated multiple times resulting in the current edition of the DSM-5.

The DSM was created by over a hundred and sixty clinicians and researchers from all over the globe. The purpose of creating the DSM is to provide a handbook for mental health professionals and other healthcare workers.

The DSM includes lists of symptoms and criteria that they can use in order to diagnose patients with mental disorders. This guidebook helps to make diagnosis and communication about mental illness more consistent.

Over the years, the book has continued to be updated and revised as there is research consistently happening on an ongoing basis around mental health disorders. These revisions help to keep the book accurate for our current day in order to help the most amounts of people. The most recent additions to the book were made in order to include symptoms that people were commonly experiencing with mental disorders such as PTSD, but we’re not already included in the book.

What Are The Implications Of The Dsm

Changes in the diagnostic criteria have minimal impact on prevalence. National estimates of PTSD prevalence suggest that DSM-5 rates were only slightly lower than DSM-IV for both lifetime and past-12 month . When cases met criteria for DSM-IV, but not DSM-5, this was primarily due the revision excluding sudden unexpected death of a loved one from Criterion A in the DSM-5. The other reason was a failure to have one avoidance symptom. When cases met criteria for DSM-5, but not DSM-IV, this was primarily due to not meeting DSM-IV avoidance/numbing and/or arousal criteria . Research also suggests that similarly to DSM-IV, prevalence of PTSD for DSM-5 was higher among women than men, and increased with multiple traumatic event exposure .

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Criterion G: Functional Significance

The PTSD symptoms experienced by the person with the diagnosis must create distress or functional impairment in a persons life.

For example, a veteran who suffers from PTSD and currently works in an office setting may find that he has difficulty concentrating and is irritable toward his coworkers. These symptoms may harm his job performance. A college student who experienced sexual assault at a party may find that their friendships are affected by their negative affect, hypervigilance, and avoidance of other social events.

Criterion E: Changes In Arousal And Reactivity

PTSD diagnosis requires a significant change in arousal and reactivity. This change in arousal and reactivity must have arisen or worsened after the traumatic event and must consist of at least two of the following symptoms.

• Increased irritability and aggression, either verbal or physical
• Participating in risky or self-destructive behavior
• Difficulty concentrating
• Increased startle response

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Cfa Of A Priori Models And Reduced Model

Five separate CFAs were run using factor structures supported in previous studies that examined measures designed to assess DSM-5 PTSD . In chi-square difference testing, the 7-factor model was a significantly better fit when compared to the four other nested models used for comparison = 69.820, p< .001 Dysphoric Arousal, ÎÏ2 = 37.916, p< .001 Externalizing Behaviors, ÎÏ2 = 16.792, p = .010 Anhedonia, ÎÏ2 = 24.145, p< .001). All models demonstrated good fit, and additional fit statistics are presented in Table 3.

Criterion A: Exposure To Trauma

PTSD begins with criterion A, which requires exposure to a traumatic event. Criterion A is not only the most fundamental part of the nosology of PTSD, but also its most controversial aspect . Some trauma experts criticized criterion A in the DSM-IV as too inclusive and warned that this change had the potential to promote conceptual bracket creep or criterion creep . Some authors questioned the value of criterion A altogether , even suggesting that it should be abolished . Criterion A was retained in the DSM-5, but it was modified to restrict its inclusiveness.

Not all stressful events involve trauma. The DSM-5 definition of trauma requires actual or threatened death, serious injury, or sexual violence . Stressful events not involving an immediate threat to life or physical injury such as psychosocial stressors are not considered trauma in this definition.

Exposure to trauma is the foundation for the rest of the criteria that comprise the diagnosis of PTSD . Breslau et al. emphasized that the link between PTSD symptoms and exposure to a traumatic event is what makes the diagnosis of PTSD a distinct disorder. They posed the question, Without exposure to trauma, what is posttraumatic about the ensuing syndrome? . North et al. whimsically added that without exposure to trauma, a syndrome following a nontraumatic stressor might more appropriately be named poststressor stress disorder and one associated with no identified stressor called nonstressor stress disorder.

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Changes From Previous Pcl For Dsm

Several important revisions were made to the PCL in updating it for DSM-5:

• PCL for DSM-IV has 3 versions, PCL-M , PCL-C , and PCL-S , which vary slightly in the instructions and wording of the phrase referring to the index event. PCL-5 is most similar to the PCL-S version. There are no corresponding PCL-M or PCL-C versions of PCL-5.
• Although there is only one version of the PCL-5 items, there are 3 formats of the PCL-5 measure, including one without a Criterion A component, one with a Criterion A component, and one with the Life Events Checklist for DSM-5 and extended Criterion A component.
• The PCL-5 is a 20-item questionnaire, corresponding to the DSM-5 symptom criteria for PTSD. The wording of PCL-5 items reflects both changes to existing symptoms and the addition of new symptoms in DSM-5.
• The self-report rating scale is 0-4 for each symptom, reflecting a change from 1-5 in the DSM-IV version. Rating scale descriptors are the same: “Not at all,” “A little bit,” Moderately,” “Quite a bit,” and “Extremely.”
• The change in the rating scale, combined with the increase from 17 to 20 items means that PCL-5 scores are not compatible with PCL for DSM-IV scores and cannot be used interchangeably.

Disinhibited Social Engagement Disorder

In many cases, children go through a distinct phase of stranger anxiety. Its an important developmental milestone to help them learn about intuition and boundaries.

Children living with disinhibited social engagement disorder , on the other hand, may not be afraid of unfamiliar people or strangers. suggests this adaptation stems from severe conditions early on, such as extreme neglect or abuse.

Children living with this diagnosis may:

• appear overly affectionate with acquaintances
• feel comfortable leaving their caregivers
• wander off with unfamiliar people

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Suicide Risk And Comorbidities

Traumatic events increase a persons suicide risk, and PTSD is strongly associated with suicidal ideation and suicidal attempts.

PTSD is also linked to other mental disorders. According to DSM-5, those with PTSD are 80% more likely than those without it to have symptoms that meet the diagnostic criteria for at least one other mental disorder, such as depressive, bipolar, anxiety, or substance abuse disorders. Although females are at greater risk of PTSD, males diagnosed with PTSD are more likely to have a comorbidity. Among Afghanistan and Iraq veterans, its been found that the co-occurrence of PTSD and a mild traumatic brain injury was 48%.

Negative Changes In Thoughts And Mood

People with PTSD may experience a pervasive negative emotional state . Other symptoms in this category include:

• Inability to remember an important aspect of the event
• Persistent and elevated negative evaluations about oneself, others, or the world
• Elevated self-blame or blame of others about the cause or consequence of the event
• Loss of interest in previously enjoyable activities
• Feeling detached from others
• Inability to experience positive emotions

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Criterion C: Avoidance Symptoms

The third criterion for a PTSD diagnosis is avoidance of reminders of the trauma.

This could be an avoidance of thoughts or feelings about the event or avoidance of trauma-related reminders altogether. A person who suffered sexual assault may display avoidance of thoughts and feelings of the assault and do their best to never think about the event.

Someone who witnessed a person drowning may avoid trauma-related reminders and stay away from pools or bodies of water, for example.

In the case of military veterans, they may avoid any depictions of violence to avoid reminders of their own trauma. For a diagnosis of PTSD, the presence of at least one of these symptoms is required.

Exposure To Ptes And Probable Ptsd Diagnosis

Responses on the HTQ revealed that participants in this sample had been exposed to multiple types of PTEs. On average, participants had experienced 5.68 types of PTEs, with the vast majority reporting exposure to at least one type of PTE. The frequency of exposure to PTEs are summarised in Table . Participants most commonly experienced lack of food or water and being close to death . Additionally, more than one third of the sample had experienced imprisonment and/or torture , and just under one fifth were survivors of rape or sexual abuse . A total of 51 participants were identified as having a probable diagnosis of PTSD.

Table 3 Frequency of Exposure to Potentially Traumatic Events

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What Helps With Ptsd And Complex Ptsd

There are two particular interventions that are generally recommended if a child or young person has a diagnosis of PTSD : Trauma-focused Cognitive Behavioural Therapy and Eye Movement Desensitisation and Reprocessing . Research has consistently found that these are effective for PTSD in children and young people. However that does not mean that they will work for all children with PTSD and some research indicates that other approaches might also be effective .

There is much less research evidence about what interventions are effective for Complex PTSD, however there is emerging evidence that what works for PTSD is likely to be effective for Complex PTSD , but it may require more sessions and more focus on developing a trusting relationship .

Criterion E: Alterations In Arousal And Reactivity

For a diagnosis of PTSD, at least two of the following symptoms that began or worsened after the stressor must be present:

• Irritability or aggression
• Risky or destructive behavior
• Increased startle reaction
• Difficulty concentrating or sleep disturbances.

These alterations in arousal and reactivity are a defense mechanism for preventing further trauma.

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What Is Complex Ptsd

It has long been recognised that the reactions of some people following traumatic events extend beyond previous definitions of PTSD . The DSM-5 took this into account with their wide approach as mentioned above. In contrast, the approach taken by ICD-11 was to formally define a new diagnosis of Complex PTSD. According to the ICD-11, Complex PTSD consists of the same core symptoms of PTSD, but has three additional groups of symptoms :

• Problems in affect regulation
• Beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event
• Difficulties in sustaining relationships and in feeling close to others

Research has indicated that the diagnosis of Complex PTSD can apply to children and young people. In one study, of those taking part in a treatment trial for PTSD, 40% of them had high levels of the additional symptoms required for Complex PTSD .

Ptsd With Dissociative Features

• With dissociative symptoms . :272, :1145

• All the PTSD criteria are met
• “High levels of depersonalization or derealization” are also present
• Dissociative symptoms are not linked to substance use or another medical condition
• it is found in both children and adults

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Criterion B: Intrusion Symptoms

The traumatic event is persistently re-experienced in one or more of the following ways:

• Recurrent, involuntary, and intrusive memories. Children older than six may express this symptom through repetitive play in which aspects of the trauma are expressed.
• Traumatic nightmares or upsetting dreams with content related to the event. Children may have frightening dreams without content related to the trauma.
• Dissociative reactions, such as flashbacks, in which it feels like the experience is happening again. These may occur on a continuum ranging from brief episodes to complete loss of awareness. Children may re-enact the events in play.
• Intense or prolonged distress after exposure to traumatic reminders.

Additional Criteria And Specifiers

A new set of PTSD criteria was added for children six years of age or younger to reflect their levels of development. The criteria for younger children do not have the repeated or extreme exposure to aversive details of the traumatic event exposure type, have only three symptom groups consisting of a total of 16 symptoms, have different symptoms grouped together compared to the adult symptom criteria, and indirect trauma exposure through a close associate is limited to a parent or care-giving figure. Additionally, intrusive memories in younger children do not have to appear distressing and nightmares do not have to be contextually based on the traumatic event.

The DSM-5 introduced a new dissociative features specifier to note the presence of associated persistent or recurrent depersonalization or derealization symptoms. This new feature of the disorder is a reflection of the focus of the DSM-5 Trauma, PTSD, and Dissociative Disorders Sub-Work Group of the Anxiety Disorders Work Group committee that proposed the new PTSD criteria.

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