PTSD in the DSM-5

DSM5 DSMIVWhat 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?

5 thoughts on “PTSD in the DSM-5

  1. Thank you for posting this! I’m interested in seeing how the prevalence of the diagnosis changes when including the new cluster. I am not in clinical practice, so I cannot speak to the applied implications. However, these seem like positive changes in the characterization of the disorder.

  2. As I have published a bit on the factor structure of DSM, I was happy to see the changes to the four clusters. Less encouraging is that fact that the item about inability to remember aspects of the event has been retained despite the fact that many studies (particularly factor analyses) have failed to support this item’s inclusion. Further, the new item aimed at capturing some of the aspects of Complex PTSD performed very poorly in the field trial (in terms of both factor analysis as well as IRT analyses) and yet was retained. The PTSD diagnosis is so very controversial (and its effects are so important) that APA must learn to rely more on science and less on politics. Until that happens, we will be stuck with a less than ideal conceptualization.

  3. Hi Eva,

    This is a great summary- thanks for sharing! It will be interesting to see how this new conceptualization applies to children.

  4. I feel like the human element has been left out in the cold. DSM is overpathologizing and the Obama Brain Campaign is underway. All the research money is going to Clarity and discovering what neural clusters do. But the NIMH alternative is a little ways out so we are saddled with this and it needs an alternative. We need a Lorax for psychiatry, defending the human right to exist.

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