DSM-5 Criteria For Posttraumatic Stress Disorder Research Articles

Clinical Utility of Impact of Event Scale-Revised for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition Posttraumatic Stress Disorder.

The Impact of Event Scale-Revised (IES-R) is a widely used self-report for assessing posttraumatic stress disorder (PTSD), originally aligned with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic criteria. This study aimed to evaluate the applicability of the IES-R under the DSM-5 guidelines and establish a cutoff point for DSM-5 PTSD diagnosis. A total of 238 participants recruited from multiple psychiatric centers, including 67 patients with PTSD, 72 patients with psychiatric controls, and 99 healthy controls, were included in the study. All participants completed the Korean version of the Structured Clinical Interview for the DSM-5 research version to confirm the presence of PTSD, the Korean version of PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Spielberger State Trait Anxiety Inventory. The IES-R demonstrated good internal consistency and a high correlation with the PCL-5. Through factor analysis, 5 distinct dimensions emerged within the IES-R: sleep disturbance, intrusion, hyperarousal, avoidance, and numbness-dissociation. A proposed cutoff score of 25 on the IES-R was suggested for identifying patients with PTSD. These findings underscore the scale's concurrent validity with the DSM-5 PTSD criteria and its effectiveness as a screening tool. Implementing a cutoff score of 25 on the IES-R can enhance its utility in identifying DSM-5 PTSD cases.

Subgroup differences in PTSD symptom presentations: A latent class analysis

Posttraumatic stress disorder (PTSD) is a highly heterogeneous disorder (Galatzer-Levy & Bryant, 2013). Mixture modeling has been used to identify homogeneous subgroups of individuals based on patterns of PTSD symptom expression. However, most of these studies are based on DSM-IV rather than DSM-5 PTSD criteria. In addition, these studies employ different indicators of latent class membership, which contributes to variability in the number and nature of latent classes identified. Additionally, there is relatively limited construct validity evidence of identified latent classes. To address these limitations, a latent class analysis (LCA) of DSM-5 PTSD symptoms was conducted in a sample of undergraduate students (N = 322) who met criteria for a subthreshold diagnosis of PTSD. The current study aimed to replicate and extend findings from the limited number of LCAs of DSM-5 PTSD criteria and examine how resulting classes meaningfully differ in external correlates. Findings revealed a three-class solution: Low Anhedonia/Externalizing Behaviors (EB), Moderate Symptoms, and High Symptoms of PTSD. Relative to the other classes, the High Symptoms class was characterized by elevated anxiety and somatic symptoms on the Personality Assessment Inventory (PAI; Morey, 1991). Relative to the Low Anhedonia/EB, the Moderate Symptoms class was characterized by numerous psychopathology domains, including depression and borderline personality traits. Results from this study suggest that, beyond classes characterized by similar PTSD symptom severity across symptoms, some individuals with similar overall PTSD symptom severity differed based on depressive symptom characteristics. Implications and future directions are discussed.

Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth.

Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD-11) significantly confounds both research and practice. Using a diverse sample of trauma-exposed youth (N = 1,542, age range: 8-20 years), we compared these two diagnostic approaches along with an expanded version of the ICD-11 PTSD criteria that included three additional reexperiencing symptoms (ICD-11+). Within the sample, PTSD was more prevalent using the DSM-5 criteria (25.7%) compared to the ICD-11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ =.57. The inclusion of additional reexperiencing symptoms (i.e., ICD-11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM-5 criteria, κ =.73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%-83.6%). Most youths who met the DSM-5 PTSD criteria also met the criteria for ICD-11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD-11+ criteria (95.5%). Symptom-level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM-5 and ICD-11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM-5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM-5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth.

Traumatic events and posttraumatic stress symptoms in a treatment-seeking sample of Ukrainian children during the war

BackgroundThe Russian invasion of Ukraine resulted in a dramatic increase of children and adolescents being confronted with war and other traumatic experiences, which could result in an increase of trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) in an entire generation. This study aims at reporting the prevalence of traumatic events, PTSD, and Complex PTSD (CPTSD) in children and adolescents seeking for mental health treatment since the Russian invasion. Additionally, the consistency of child and caregiver reported trauma, PTSD and CPTSD will be examined.MethodsThis study is part of the “TF-CBT Ukraine” project in which Ukrainian therapists were trained in assessing their patients via the “Child and Adolescent Trauma Screen” (CATS-2) before initiating trauma-focused treatment, if indicated. Altogether N = 200 Ukrainian children and adolescents (Mage = 12.01, range 4–21; 62.0% female) were included in the study between October 2022 and August 2023. Data were analysed descriptively, via t-tests and bivariate correlations.ResultsThe children and adolescents reported on average four different traumatic events, most frequently war (n = 123; 68.7%), bullying threats (n = 71; 39.7%) and domestic violence (n = 68; 38.0%). Almost 70% (n = 123) of the participants fulfilled the DSM-5 PTSD criteria, 31% (n = 56) fulfilled the ICD-11 PTSD criteria and 21% (n = 38) the ICD-11 CPTSD criteria. Rates of PTSD were even higher in preschool children (95%). The comparisons of self-and caregiver reports on traumatic events and PTSD/CPTSD severity scores indicated moderate to high correlations between the patients and their caregivers (r = 0.710–0.767).ConclusionsThis study shows that Ukrainian children and adolescents starting treatment report a high number of traumatic events and trauma-related symptoms, which could have a long-lasting negative impact on their social-emotional development and quality of life. The implementation of evidence-based trauma-focused interventions for these children is therefore crucial.

Low-Cost Virtual Reality to Support Imaginal Exposure Within PTSD Treatment: A Case Report Study Within a Community Mental Healthcare Setting

Revisiting what happened during (or after) a traumatic event is an important part of the treatment process in trauma-focused cognitive therapy (TF-CT). However, clinicians may have difficulty helping patients to intentionally retrieve these memories in order to engage with their content. As such, clinical tools to support the access and delivery of imaginal exposure content within treatment may prove to be particularly useful for therapists. This case report introduces work undertaken with Mr. A, a 38-year-old male, who 2 years prior had experienced a city centre assault. Initial assessment revealed a PCL-5 score of 64 and he met DSM-5 criteria for posttraumatic stress disorder (PTSD). Mr. A received 10 sessions of TF-CT wherein the traditional imaginal exposure components were implemented via a newly developed virtual reality (VR) development workflow called “VR Photoscan.” After 10 sessions, results showed PCL-5 scores decreased from 64 to 19 and Mr. A no longer met DSM-5 PTSD criteria. VR Photoscan was used during 4/10 sessions and included (1) reliving, (2) memory updating, and (3) stimulus discrimination activities. Mr. A also reported VR Photoscan as helpful regarding preparation for site visits. In conclusion, VR Photoscan technology provided a more visceral exposure experience which supported Mr. A to revisit the trauma memory. He reported high levels of satisfaction with the quality of the virtual environment and no issues using the VR technology. Produced with lower costs and shorter development times than typical computer-generated environments, VR Photoscan may be more easily implemented within routine care, although further research is required.

Prevalence of the dissociative subtype of post-traumatic stress disorder: a systematic review and meta-analysis.

The dissociative subtype of post-traumatic stress disorder (PTSD-DS) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is characterised by symptoms of either depersonalisation or derealisation, in addition to a diagnosis of post-traumatic stress disorder (PTSD). This systematic review and meta-analysis sought to estimate the point prevalence of current PTSD-DS, and the extent to which method of assessment, demographic and trauma variables moderate this estimate, across different methods of prevalence estimation. Studies included were identified by searching MEDLINE (EBSCO), PsycInfo, CINAHL, Academic Search Complete and PTSDpubs, yielding 49 studies that met the inclusion criteria (N = 8214 participants). A random-effects meta-analysis estimated the prevalence of PTSD-DS as 38.1% (95% CI 31.5-45.0%) across all samples, 45.5% (95% CI 37.7-53.4%) across all diagnosis-based and clinical cut-off samples, 22.8% (95% CI 14.8-32.0%) across all latent class analysis (LCA) and latent profile analysis (LPA) samples and 48.1% (95% CI 35.0-61.3%) across samples which strictly used the DSM-5 PTSD criteria; all as a proportion of those already with a diagnosis of PTSD. All results were characterised by high levels of heterogeneity, limiting generalisability. Moderator analyses mostly failed to identify sources of heterogeneity. PTSD-DS was more prevalent in children compared to adults, and in diagnosis-based and clinical cut-off samples compared to LCA and LPA samples. Risk of bias was not significantly related to prevalence estimates. The implications of these results are discussed further.

A crosswalk study of DSM-IV and DSM-5 criteria for PTSD from the DSM-5 Field Trials

Objective: Posttraumatic stress disorder (PTSD) is prevalent and sometimes severely disabling. Providing effective treatment for PTSD and addressing its social consequences require accurate diagnosis. PTSD criteria have changed in all editions of the American Diagnostic Criteria since introduction of the diagnosis in DSM-III in 1980. The DSM-5 Field Trials demonstrated very good inter-rater reliability for PTSD, but a crosswalk study comparing DSM-IV and DSM-5 criteria has potential to identify diagnostic differences generated by changed criteria. Methods: A DSM-IV to DSM-5 PTSD crosswalk study was conducted in real-world adult clinical treatment settings in two DSM-5 Field Trials sites, the Dallas (N = 93) and Houston (N = 48) Veterans Affairs medical centers. The crosswalk assessment was conducted by trained clinicians who interviewed the patients and rated both sets of criteria on a combined checklist. Results: PTSD prevalence differed insubstantially between criteria sets (42% vs. 45% and 55% vs. 52% in the Dallas and Houston sites, respectively), with moderate to excellent diagnostic agreement (reliability indicated, respectively, by κ = .53 and .93); however, substantial proportions of individuals diagnosed in one criteria set did not meet criteria in the other. Differences in cross-criteria diagnostic reliability were largely a function of differing definitions of criterion A trauma. Conclusions: Reliability across the two criteria sets was generally good to excellent, and diagnostic discrepancy predominantly reflected the elimination of criterion A2 in DSM-5 with a smaller contribution from changes to the avoidance and numbing criteria.

Trauma Exposure and Prolonged Grief Disorder Among Persons Receiving Community Mental Health Services: Rates and Correlates.

BackgroundPersons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied.AimsThe present study investigated the rate of both PTSD and PGD among clients receiving community mental health services, and the clinical correlates of co-occurring PTSD/PGD.MethodsTrauma history, PTSD and PGD were assessed among 536 individuals receiving community mental health services (Study 1). A subsample of 127 individuals from Study 1 who met DSM-5 criteria for PTSD based on diagnostic interview completed measures of psychiatric symptoms (Study 2).ResultsIn Study 1, 92.4% of participants receiving community mental health services had experienced a traumatic event, 49.6% met criteria for probable and provisional PTSD, 14.7% scored positive for probable PGD, and 11.9% met criteria for probable and provisional PTSD as well as probable PGD. In Study 2, participants meeting diagnostic DSM-5 criteria for PTSD and probable PGD had more self-reported PTSD symptoms, but did not differ on other outcomes.ConclusionsFindings highlight the need for trauma informed services including grief counseling for persons with SMI.

Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

BackgroundExposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs).MethodsData were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms.ResultsThe most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria.ConclusionsNearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

Randomized, Placebo-Controlled Trial of the Angiotensin Receptor Antagonist Losartan for Posttraumatic Stress Disorder

BackgroundEvidence-based pharmacological treatments for posttraumatic stress disorder (PTSD) are few and of limited efficacy. Previous work suggests that angiotensin type 1 receptor inhibition facilitates fear inhibition and extinction, important for recovery from PTSD. This study tests the efficacy of the angiotensin type 1 receptor antagonist losartan, an antihypertensive drug, repurposed for the treatment of PTSD. MethodsA randomized controlled trial was conducted for 10 weeks in 149 men and women meeting DSM-5 PTSD criteria. Losartan (vs. placebo) was flexibly titrated from 25 to 100 mg/day by week 6 and held at highest tolerated dose until week 10. Primary outcome was the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) change score at 10 weeks from baseline. A key secondary outcome was change in CAPS-5 associated with a single nucleotide polymorphism of the ACE gene. Additional secondary outcomes included changes in the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9, and proportion of responders with a Clinical Global Impressions–Improvement scale of “much improved” or “very much improved.” ResultsBoth groups had robust improvement in PTSD symptoms, but there was no significant difference on the primary end point, CAPS-5 measured as week 10 change from baseline, between losartan and placebo (mean change difference, 0.9, 95% confidence interval, −3.2 to 5.0). There was no significant difference in the proportion of Clinical Global Impressions–Improvement scale responders for losartan (58.6%) versus placebo (57.9%), no significant differences in changes in PTSD Checklist for DSM-5 or Patient Health Questionnaire-9, and no association between ACE genotype and CAPS-5 improvement on losartan. ConclusionsAt these doses and durations, there was no significant benefit of losartan compared with placebo for the treatment of PTSD. We discuss implications for failure to determine the benefit of a repurposed drug with strong a priori expectations of success based on preclinical and epidemiological data.

Developing a Screening Tool for Young Children Using an Ecological Framework.

Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never assessed. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n=60) to test its feasibility for use with caregivers of children ages 3-5 in low-resource settings. We developed an item pool across three domains (child, caregiver, environment), vetted it with experts, and conducted cognitive interviewing with parents (n=15) and case managers (n-10). Simultaneously, we built an online, user-friendly delivery platform. We used a one parameter Item Response Model and a Rasch-based Rating Scale Model (RSM) and fit confirmatory factor analytic (CFA) models to test for unidimensional and construct validity. The results support the feasibility of screening children from low SES populations within low-resource settings using an ecological perspective and supports the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.

1080 Self-reported Hyperarousal Predicts Lower Parasympathetic Activity During Slow-Wave Sleep In Trauma-exposed Individuals

Abstract Introduction Hyperarousal and abnormal autonomic functioning are among the core manifestations of posttraumatic stress disorder (PTSD). In this study, we examined the association of parasympathetic activity during slow wave sleep (SWS) with self-reported hyperarousal measures in recently traumatized individuals. Methods Individuals exposed to a PTSD Criterion-A trauma within the past 2 years (N=76) aged 18-40 (mean 24.06, SD 4.76), of whom 43% met DSM-5 criteria for PTSD, underwent a night of ambulatory polysomnography (PSG) following an acclimation night. ECG recordings during SWS-sleep periods of at least 5 min were analyzed for 2 parasympathetic indices: Root Mean Square of the Successive Differences (RMSSD) and High Frequency (0.14-0.4Hz) power (HF power) using Kubios software. Hyperarousal indices included the hyperarousal items from the PTSD Checklist for DSM-5 (PCL-5) excluding the sleep item #20 (PCLhyp), those from the Clinician-Administered PTSD Scale (CAPS-5) including sleep items (CAPShyp), as well as a published Hyperarousal Scale (HAS) and Hypervigilance Questionnaire (HVQ). In addition, a Composite Hyperarousal Index (CHI) was computed from combined hyperarousal items on the PCL-5 and the CAPS-5 as well as the HAS total score. Results SWS RMSSD was negatively associated with PCLhyp (R = -.244, p = 0.035), CAPShyp (R = -.250, p = 0.03), CHI (R = -.280, p = 0.014), and HAS (R = -.229, p = 0.049). SWS HF power was negatively associated with CHI (R = -.227, p = 0.049). Conclusion The hyperarousal (Criterion E) symptoms of PTSD are associated with lowered parasympathetic tone during SWS across the spectrum of posttraumatic severity from resilient individuals to those diagnosed with PTSD. Support R01MH109638

Mothers’ emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn

BackgroundVarious emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury. MethodsData from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3). ResultsBased on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms. LimitationsThe posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria. ConclusionsThis study suggests that mothers’ acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents’ early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

Examining various subthreshold definitions of PTSD using the Clinician Administered PTSD Scale for DSM-5

BackgroundThe Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013) includes Other- and Unspecified- Trauma and Stressor-Related Disorders to capture subthreshold Posttraumatic Stress Disorder (PTSD) symptoms. However, the DSM-5 does not specify the number or type of symptoms needed to assign them. The purpose of the current study was to extend our understanding of subthreshold PTSD by comparing four commonly used definitions adapted to the DSM-5 PTSD criteria in an outpatient treatment-seeking sample. MethodsVeterans (N = 193) presenting to PTSD clinics were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Participants reported a criterion A traumatic event, but did not meet criteria for threshold-PTSD. We hypothesized that the number of veterans captured would be highest when fewer specific criterion sets were required by the subthreshold definition. ResultsOur hypothesis was upheld in that the more criteria required by the subthreshold PTSD definition, the lower the number of veterans counted within the group. LimitationsThe study consisted primarily of trauma treatment-seeking male veterans, with chronic PTSD symptoms. In addition, the sample size was small and was collected as part of routine clinical care. ConclusionsThese results support previous contentions around careful decision making when defining what constitutes subthreshold PTSD in research and clinical work. It also points to the need for continued research to better understand the diagnostic and treatment implications of subthreshold PTSD.

A confirmatory factor analysis of the PTSD checklist 5 in veteran and college student samples

An important change in the conceptualization of posttraumatic stress disorder (PTSD) has been the shift from a three-factor model used in the DSM-IV-TR to the current four-factor model used in DSM-5. Early research initially supported the three-factor model, but most recent data suggest a four-factor model provides the best fit. Still other research has examined evidence for a five-factor model that would include depression sequelae. By way of a confirmatory factor analysis, we demonstrate the reliability of DSM-5 PTSD criteria clustering in a sample of 124 OEF/OIF/OND Veterans treated at a VAMC (49% white, 89% men) and a sample of 737 college students (48% white, 78% women). All participants were trauma-exposed, and completed the PTSD Checklist for DSM-5. The current study shows both samples best support a five-factor model over two four factor models considered for the DSM-5, though none provided better than moderate fit. Implications of the current findings regarding the reliability of the new DSM-5 criteria of PTSD will be discussed.

DSM-5 criteria for PTSD in parents of pediatric patients with epilepsy: What are the changes with respect to DSM-IV-TR?

Increasing literature suggests the need to explore for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy. The aim of the present study was to estimate full and partial PTSD rates among parents of children with epilepsy comparing DSM-5 and DSM-IV-TR criteria. Further, the aim of the present study was to examine possible gender differences between mothers and fathers. Results showed 9.1% and 12.1% PTSD rates in the total sample, according to DSM-5 or DSM-IV-TR criteria, respectively, with an overall consistency of 92.9% (Kohen's K=0.628, p=.453). Significant gender differences emerged for Avoidance/Numbing and Hyperarousal symptoms diagnosed by means of DSM-IV-TR criteria, as well as for Negative alterations in cognitions/mood and Hyperarousal symptoms, when adopting DSM-5 criteria. This study underscores the relevance of detecting PTSD in parents of children with a chronic illness such as epilepsy.

DSM-5 Post-Traumatic Stress Disorder Criteria in "Precious" (2009): Media Content Analysis for Educational Purposes.

DSM-5 Post-Traumatic Stress Disorder Criteria in "Precious" (2009): Media Content Analysis for Educational Purposes.

The Association of Post-traumatic and Postmigration Stress with Pain and Other Somatic Symptoms: An Explorative Analysis in Traumatized Refugees and Asylum Seekers.

Post-traumatic stress disorder (PTSD) and somatic symptoms, such as pain, are frequently seen in refugees. Their relationship is poorly understood, and the treatment of these comorbid conditions can be very challenging. The current cross-sectional study examined pain and other somatic symptoms and their relationship with trauma history, PTSD symptom clusters, and current living difficulties among treatment-seeking refugees. One hundred thirty-four treatment-seeking traumatized refugees (78% male, mean age = 42 years) were assessed regarding lifetime traumatic experiences, symptoms of post-traumatic stress, overall pain and somatic symptoms, and postmigration living difficulties. An exploratory factor analysis of the 12 somatic symptoms revealed two distinct factors: somatic symptoms related to bodily dysfunction ("weakness") and somatic symptoms related to increased sympathetic activity ("arousal"). DSM-5 PTSD Criteria D "alterations in cognitions and mood" and E "alterations in arousal and reactivity" were primarily related to "weakness," while PTSD Criterion E "alterations in arousal and reactivity" and postmigration living difficulties were associated with "arousal." Overall pain was associated primarily with living difficulties and PTSD Criterion D and Criterion E. Results indicate that somatic symptoms are of considerable concern among traumatized refugees and that different patterns of somatic symptoms are associated with different clusters of PTSD symptoms. The findings contribute to the better understanding of the symptom presentation of traumatized people who are experiencing somatization and potentially inform treatment directions and highlight the importance of screening for PTSD in refugees presenting with pain and somatic symptoms.

PTSD or not PTSD? Comparing the proposed ICD-11 and the DSM-5 PTSD criteria among young survivors of the 2011 Norway attacks and their parents.

The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves. Young survivors of the 2011 Norway attacks (n = 325) and their parents (n = 451) were interviewed at 4-6 months (wave 1) and 15-18 months (wave 2) after the shooting. PTSD was assessed with the UCLA PTSD Reaction Index for DSM-IV adapted for DSM-5, and a subset was used as diagnostic criteria for ICD-11. In survivors, PTSD prevalence did not differ significantly at any time point, but in parents, the DSM-5 algorithm produced significantly higher prevalence rates than the ICD-11 criteria. The overlap was fair for survivors, but amongst parents a large proportion of individuals met the criteria for only one of the diagnostic systems. No systematic differences were found between ICD-11 and DSM-5 in predictive validity. The proposed ICD-11 criteria and the DSM-5 criteria performed equally well when identifying individuals in distress. Nevertheless, the overlap between those meeting the PTSD diagnosis for both ICD-11 and DSM-5 was disturbingly low, with the ICD-11 criteria identifying fewer people than the DSM-5. This represents a major challenge in identifying individuals suffering from PTSD worldwide, possibly resulting in overtreatment or unmet needs for trauma-specific treatment, depending on the area of the world in which patients are being diagnosed.

Examining potential overlap of DSM-5 PTSD criteria D and E.

The Diagnostic and Statistical Manual, Fifth Edition-5 (DSM-5) has adopted a four-factor symptom model for Posttraumatic Stress Disorder (PTSD) that includes new symptom additions in criterion D (D2, D3, D4), negative alterations in cognition and mood. This article examines potential overlapping endorsement of these symptoms amongst one another and with the behavioral symptoms within PTSD criterion E (E1 and E3; alterations in arousal and reactivity), through the lenses of cognitive-behavioral theory. Responses of veteran participants (N=320) completing the PTSD Checklist-5 were used to determine overlap in symptom reporting. We conducted a series of direct logistic regressions to determine the predictive ability of meeting the criterion D or E symptoms based on endorsement of the target D symptoms (D2, D3, D4). Results suggest that the new cognitive and emotional symptoms of criterion D have significant overlapping content, and that thought-related symptoms are often endorsed in conjunction with their behavioral counterpoint (D2/E3; D4/E1). Our results suggest that DSM-5 criterion D symptoms may not be central to the diagnostic structure of PTSD. These symptoms add complexity and difficulty to diagnosing PTSD without adding much unique content.