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Proposed Changes to the PTSD Diagnosis in DSM-5

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Updated June 13, 2014

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A number of mental health professionals have proposed revisions to the PTSD diagnosis for the next version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

Even though the symptoms of PTSD have been recognized throughout history, it wasn't until 1980 that that the diagnosis of PTSD as we know it today came to be. Before that time, the symptoms of PTSD were primarily referred to as "shell shock," "combat fatigue," or "war neurosis." Since 1980, there has been an extensive amount of research on the symptoms and consequences of PTSD. As a result of this research, there is some thought that the symptoms of PTSD, as well as how we diagnose PTSD, could use some revision.

In May 2013, the DSM-5 will come out, and this is how they expect PTSD and its diagnosis to look:

Criterion A

A person was exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation. In addition, these events were experienced in one or more of the following ways:

  1. The event was experienced by the person.
  2. The event was witnessed by the person as it occurred to someone else.
  3. The person learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death.
  4. The person experienced repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse.

Criterion B

A person experiences at least one the following intrusive symptoms associated with the traumatic event:

  1. Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
  2. Repeated upsetting dreams where the content of the dreams are related to the traumatic event
  3. The experience of some type of dissociation (for example, flashbacks) where the person feels as though the traumatic event is happening again
  4. Strong and persistent distress upon exposure to cues that are either inside or outside of a person's body that are connected to the person's traumatic event
  5. Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event

Criterion C

Frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:

  1. Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
  2. Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event

Criterion D

At least three of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:

  1. The inability to remember an important aspect of the traumatic event
  2. Persistent and elevated negative evaluations about one's self, others, or the world (for example, "I am unlovable," or "The world is an evil place")
  3. Elevated self-blame or blame of others about the cause or consequence of a traumatic event
  4. A negative emotional state (for example, shame, anger, fear) that is pervasive
  5. Loss of interest in activities that one used to enjoy
  6. Feeling detached from others
  7. The inability to experience positive emotions (for example, happiness, love, joy)

Criterion E

At least three of the following changes in arousal that started or worsened following the experience of a traumatic event:

  1. Irritability or aggressive behavior
  2. Impulsive or self-destructive behavior
  3. Feeling constantly "on guard" or like danger is lurking around every corner (or hypervigilance)
  4. Heightened startle response
  5. Difficulty concentrating
  6. Problems sleeping

Criterion F

The above symptoms last for more than one month.

Criterion G

The symptoms bring about considerable distress and/or interfere greatly with a number of different areas of a person's life.

Criterion H

The symptoms are not due to a medical condition or some form of substance use.

Being Diagnosed with PTSD According to the DSM-5

In order to be diagnosed with PTSD according to the DSM-5, a person needs to meet Criterion A, one symptom (or more) from Criterion B, one symptom (or more) from Criterion C, three symptoms (or more) from Criterion D, 3 symptoms (or more) from Criterion E, and Criterion F through H.

Potential Benefits of the Proposed Revisions

As you can see, there are quite a few changes from how we currently think about PTSD. There are a couple of big changes that are being made. One major change is the removal of the requirement that someone needs to experience fear, helpless, or horror in response to a traumatic event in order to meet Criterion A. Another major change is the splitting up of the avoidance symptoms in DSM-IV into two separate clusters of symptoms. In the DSM-5, the avoidance symptoms of PTSD will be separated from negative changes in thoughts and mood (such as emotional numbing). It is hoped that these changes will improve mental health professionals' ability to accurately identify PTSD, as well as improve our ability to treat PTSD.

In reviewing these changes to the PTSD diagnosis, keep in mind that they are "proposed" changes at this point. At this point, nothing is set in stone. Mental health professionals are still debating about these changes, and it is likely that more changes will come. However, in the end, by May 2013, it is hoped that we will have a new set of criteria for diagnosing PTSD that will better reflect what mental health professionals are seeing in research and in their clients.

You can review the rationale behind these changes, as well as look at other changes in the DSM-5, at the website for the American Psychiatric Association.

Source:

American Psychiatric Association DSM-5 Development (website accessed April 25, 2011): http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165.

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