Diagnostiquer le trouble de stress post-traumatique chez l’enfant : le passage du DSM-IV-TR au DSM-5

Abstract

Since the publication of the DSM-IV-TR, the diagnosis of posttraumatic stress disorder (PTSD) in children has been subject to criticism from the scientific community. These criticisms essentially targeted the diagnostic criteria, which were deemed developmentally inappropriate, but also the lack of empirical data from studies of young children and the low prevalence of PTSD in children. Therefore, many alternative diagnostic algorithms were elaborated to address these limitations, in order to revise the diagnosis in the DSM-5. In this article, we start by jointly considering Cook et al.’s (2005) and van der Kolk's (2005) proposals for revision. They refer to complex trauma, which, unlike PTSD, concerns the early experience of multiple traumatic events, and which are, in most cases, of interpersonal nature, often occurring in the child's family circle. We analyze why this proposal is considered more adequate for diagnosing children. Indeed, we find two main reasons for its relevance. Firstly, children would be diagnosed with only one disorder, rather than being diagnosed with multiple comorbid disorders, which would allow a comprehensive understanding of their symptoms. Secondly, as complex trauma leads to adverse consequences on children's future lives, especially on their adult health, such a proposal would enable the development of adequate treatment. We then evaluate the arguments for and against its inclusion in the DSM-5, which indicates a lack of consensus on the proposal of complex trauma. This disagreement contributed to its exclusion from the manual. As it was rejected, we study rigorously the modifications of the revised diagnostic criteria of PTSD in the DSM-5, and compare it to the proposal of complex trauma. On the one hand, we consider the detrimental impact of this decision upon professionals, service users, as well as carers. On the other hand, we highlight its efforts to propose more appropriate diagnostic criteria for children, with the introduction of a preschool subtype. Moreover, we view the new dissociative subtype as contributing to the inclusion of an essential dimension of complex trauma in the diagnosis of PTSD. Finally, we explore another classification, that is, the ICD-11 complex PTSD, which is a non-definitive, yet promising proposal for the acknowledgment of complex trauma in children.