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.
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.
Also Check: What Qualifies As A Physical Disability
What Additional Problems Are Associated With Chronic Trauma
In addition to PTSD, chronic trauma is sometimes associated with other comorbidities including substance use, mood disorders, and personality disorders. A thorough assessment using validated instruments is critical to creating a comprehensive and effective treatment plan.
An individual who experienced a prolonged period of chronic victimization and total control by another may also experience difficulties in the following areas:
- Emotional regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
- Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body .
- Self-perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
- Distorted perceptions of the perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
- Relations with others. Examples include isolation, distrust, or a repeated search for a rescuer.
- One’s system of meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.
Research Implications And Future Progress
The more tightly defined ICD-11 diagnoses hold promise for improved biological, psychological and treatment research. The risks of the ICD approach, however, are that in reifying core PTSD symptoms as real PTSD, many of those who seek care will be marginalised and stigmatised, and PTSD research will lead to findings with a rarefied sample that are clinically irrelevant. The fallacy of the big tent approach of DSM is that the increased heterogeneity makes it ever more difficult to develop a coherent science and treatment approach, while treatment guidelines for PTSD continue to neglect the reality of the needs and challenges of the majority of patients. It is a step in the right direction that both DSM and ICD have recognised that previous versions of PTSD did not adequately capture the complex PTSD presentation. It is now time to bring treatment recommendations in line with this reality, starting with the need for a more comprehensive approach than is currently captured by first-line treatment recommendations.
Don’t Miss: California 100 Disabled Veteran Benefits
Resources And Assistance With Va Claims
Veterans have played an outsized role in spreading awareness of PTSD, especially following the recent wars in Afghanistan in Iraq. The disorder is better understood now than it ever has been in the past, and because veterans have a higher likelihood of experiencing traumatic events, we encourage any who experience the diagnostic criteria above to seek professional treatment. VA provides extensive services to help veterans cope with this disorder.
Should you have any difficult obtaining the level of treatment you need for PTSD, and need our help to increase your disability rating for PTSD, you can reach us at 844-VET-LAWS or fill out our online form.
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.
Read Also: How Long Social Security Disability Last
How Do The Dsm
Overall, the symptoms of PTSD are generally comparable between DSM-5 and DSM-IV. A few key alterations include:
- The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included.
- Criterion A2, requiring that the response to a traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy .
- The avoidance and numbing cluster in DSM-IV was separated into two criteria in DSM-5: Criterion C and Criterion D . This results in a requirement that a PTSD diagnosis includes at least one avoidance symptom.
- Three new symptoms were added:
- Criterion D : Overly negative thoughts and assumptions about oneself or the world and, negative affect
- Criterion E : Reckless or destructive behavior
Continuing Education
PTSD Overview and Treatment
The course describes the DSM-5 diagnostic criteria for PTSD and evidence-based treatments. Videos of Veterans with PTSD and clinicians are included.
What Types Of Trauma Are Proposed To Increase The Likelihood Of Complex Ptsd
Originally, proponents of complex PTSD focused on childhood trauma, especially childhood sexual trauma. However, there is abundant evidence suggesting that duration of traumatic exposureâeven if such exposure occurs entirely during adulthood as with refugees or people trapped in a long-term domestic violence situationâis most strongly linked to the concept of complex PTSD. During long-term traumas, the victim is generally held in a protracted state of captivity, physically or emotionally, according to Dr. Herman . In these situations, the victim is under the control of the perpetrator and unable to get away from the danger. Examples of such traumatic situations include: concentration camps, Prisoner of War camps, prostitution brothels, long-term domestic violence, long-term child physical abuse, long-term child sexual abuse, and organized child exploitation rings.
Read Also: Can You Get An Advance On Va Disability
Assessment In Ptsd Treatment
Assessment of PTSD can be conducted using a range of available instruments, each possessing varying strengths and weaknesses. Structured, standardized diagnostic interviews are considered the gold standard for assessing PTSD symptoms. However, because such structured interviews are time-consuming and must be administered by a trained clinician, it may not be feasible to administer them in every situation. Self-report measures of PTSD symptomatology can be used when time and resources are scarcer but they have their own limitations. Specifically, self-report instruments have fixed item content and rating scale formats, and their accuracy is contingent upon the patient understanding each item and answering truthfully.
After treatment, assessment of the symptoms that were targeted during treatment allows the clinician to determine the degree of symptom improvement by calculating reliable change and clinically significant change scores. Reliable change scores indicate the extent to which changes on scores of a particular measure are greater than the expected measurement error . Clinically, significant change scores indicate the extent to which the patients end state scores on a particular measure compare with scores observed in clinically meaningful comparison groups .
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.
Also Check: Can You Apply For Social Security Disability After Retirement
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.
Changes To The Ptsd Diagnosis And Implications For Assessment In Ptsd Treatment
In 2013, the American Psychiatric Association introduced the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders . In this version, there are some notable changes to the PTSD diagnosis, including that it is no longer included as an anxiety disorder. Instead, it is included in a new category called the trauma- and stressor-related disorders along with acute stress disorder and the adjustment disorders.
In terms of the actual diagnostic criteria, the first notable change concerns the stressor criterion . In DSM-IV, Criterion A was divided into two parts: an objective component and a subjective component . Criterion A1 required that 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 . Criterion A2 further required that the persons response involved intense fear, helplessness or horror . Criterion A in DSM-5 now requires:
Criterion A2 has been removed completely from DSM-5 because it did not improve the PTSD diagnostic accuracy .
The changes made to the PTSD diagnosis have important implications for PTSD assessment. In the following section, we describe the manner in which some of these changes to the diagnosis have particular implications for PTSD assessment within the context of treatment .
Table 1 Summary of recommendations to clinicians regarding DSM-5 changes and implications for assessment
Also Check: How Is Disability Viewed As A Social Construct
Comparison Of Child Characteristics Predictive Of Ptsd
To evaluate criterion validity, risk factors identified by prior research as being important for the emergence of PTSD were examined to determine how well they predicted the preschool or adult criteria . There was low multicollinearity and low autocorrelation . The Hosmer and Lemeshow test indicated good fit for the preschool model and adult model . Analyses revealed that the preschool-defined PTSD cases were predicted by more risk variables than the adult-defined PTSD cases , as shown in Table 2. No significant gender differences emerged for either set of criteria. However, the odds ratio for the preschool criteria was in the expected direction, whereas the odds ratio for the adult criteria was not. Significant differences emerged for Hispanic and Black children for both the preschool and adult criteria. Significant differences for other racial minority children emerged for the preschool criteria , but not for the adult criteria . Hurricane-related life threatening events and loss/disruption were related to both sets of PTSD criteria. However, perceived life threat was only associated with the preschool criteria . Stressful life events were associated with the preschool criteria , but not the adult criteria .
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%.
You May Like: Can You Lose Disability Benefits If You Inherit Money
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 .
Concepts Of Complex Ptsd
The ontological status of CPTSD has dogged psychiatry since its initial proposition. In the USA there have been two camps: one promoting a diagnosis positing that chronic and severe interpersonal trauma can lead to pervasive emotional and interpersonal difficulties and one arguing that PTSD alone is adequate . The revisions to PTSD in ICD-11 and the DSM-5 suggest consensus that a narrowly defined, fear-based model of PTSD failed to capture the full range of trauma-related presentations. However, ICD-11 and DSM-5 have taken opposite tacks in conceptualising this diversity, each solving one problem but creating another.
Read Also: Can You Go On Disability For Depression