Handbook of PTSD ch. 2

Study objectives

  1. In the DSM-5, PTSD was reclassified into a new overarching category. What was the change? Why was it made?

  • it used to be classified as an anxiety disorder

  • in the dsm 5, it was placed in the category of “trauma and stressor-related disorders”

  • differences from other anxiety disorders

  1. Briefly list some of the changes made to the PTSD diagnostic criteria in the DSM-5 (A1, A2, B-E, F-H).

  • A1: exposure to actual or threatened death, serious injury, or sexual violence by directly experiencing the traumatic event(s)

    • A2: by witnessing, in person, the event(s) as it occurred to others

  • B: presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s) beginning after the event(s) occurred

    • recurrent, involuntary, and intrusive distressing memories of the traumatic event

    • recurrent distressing dreams related to the traumatic event

    • dissociative reactions (like flashbacks) in which the individual feels like the event is recurring

    • intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

    • marked physiological reactions to internal or external cues

  • C: persistent avoidance of stimuli associated with the traumatic event beginning after the event occurred

  • D: negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the even occurred

  • E: marked alterations in arousal and reactivity associated with the traumatic event

  • F: duration of the disturbance is more than 1 month

  • H: the disturbance is not attributable to the physiological effects of a substance or another medical condition

  1. Briefly describe the evidence supporting a dissociative subtype within PTSD.

  • antecedent validators

    • dissociation is common among people with trauma-related disorders, including ptsd

  • neuroimaging data

    • suggests that a distinct neurocircuitry pattern distinguishes individuals with ptsd from those with ptsd plus dissociative symptoms

  • findings from confirmatory factor analysis

    • latent class analysis identifies a distinct subgroup characterized by high ptsd severity and dissociative symptoms

  • treatment outcome results

    • different treatments may be indicated, depending on the presence or absence of dissociative symptoms

  1. Judith Herman (1962) was the first to propose the complex-PTSD diagnosis (or Disorders of Extreme Stress Not Otherwise Specified (DESNOS) diagnosis). List the three new disorders and range of intensified symptoms that are associated with complex-PTSD.

  • dissociative identity disorder

  • borderline personality disorder

  • somatization disorder

  • symptoms:

    • behavioral difficulties, emotional difficulties, cognitive difficulties, interpersonal difficulties, and somatization (recurrent and multiple medical symptoms with no discernible organic cause)

  1. What are some of the main differences between the DSM-5 criteria for PTSD to ICD-11(11th edition of the International Classification of Diseases; World Health Organization [WHO], 2018)?

  • the DSM-5 process was much more conservative and rigorous, while ICD-11 had the latitude to be much more radical

  • ICD has ptsd and complex ptsd

  • includes 3 core elements:

    • reexperience of the traumatic event

    • avoidance of traumatic reminders

    • a persistent sense of threate

  • complex ptsd includes that and disturbances in self-organization:

    • affective dysregulation

    • negative self-concept

    • disturbed relationships

  • etiology of ptsd is seen as general exposure to an extremely threatening or horrific event

  • etiology of complex ptsd is seen as protracted exposure to prolonged or repetitive events from which escape is difficult or impossible

DSM-5 Criteria for PTSD

  • DSM 5 revision of ptsd started in 2008 and ended in 2013 with the publishing of the book

Reclassification of ptsd in dsm 5

  • during the revision process, three possibilities were considered:

    • keep ptsd as an anxiety disorder

    • classify it as a stress-related fear circuitry disorder

    • categorize it as an internalizing disorder

  • many similarities to anxiety disorders, but numbing, alienation, and detachment are more common to affective disorders

  • what distinguishes PTSD from anxiety as well as most other psychiatric disorders is the presumed relationship between exposure to a traumatic stressor and the subsequent development of the PTSD symptom profile

  • In preparing for DSM-5, the APA examined the evidence favoring a proposed diagnostic cluster, stress-related fear circuitry disorders, characterized by abnormalities in the neurocircuitry that mediate the processing of threatening or fearful stimuli