Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder?

Abstract

Criteria A2, experience of helplessness, fear, or horror at the time of the traumatic event, was removed from the posttraumatic stress disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We argue that there is empirical support for retention of A2, a criterion that has clinical value and may improve diagnostic accuracy. Specifically, we demonstrate that A2 has high negative predictive power, aids in the prediction of symptom severity, and can be indispensible to detecting the disorder in children. We examine how augmenting A2 with other peritramautic emotions could improve clinical and diagnostic utility. In our opinion, rather than being eliminated, A2 needs to be reconstructed and included as one criterion of PTSD.

Past trauma and future choices: differences in discounting in low-income, urban African Americans

“…= 9.6). This was done using DSM-IV criteria A1 (qualifying traumatic event) and A2 (experience of intense fear, helplessness, and horror in response to a criteria A1 traumatic event), which is predictive of PTSD symptom severity and has significant negative predictive power for PTSD diagnosis (for a recent reviw, see Pivovarova et al 2016).…”

The impact of coronavirus on individuals with problematic hoarding behaviours

“…Although helplessness is one of the A2 criteria for traumatic events dropped from DSM-5 for being thought to lead to false negatives (i.e. for various reasons, people may not always remember the exact nature of their peritraumatic reactions) (Pivovarova et al, 2016), we demonstrated that this specific emotional state might have a unique ability to predict greater hoarding in the context of an ongoing pandemic. Perhaps hoarding-related behaviors are a method of exerting control in a situation where individuals perceive they are devoid of control.…”

Mechanisms Underlying Unconscious Processing and Their Alterations in Post-traumatic Stress Disorder: Neuroimaging of Zero Monetary Outcomes Contextually Framed as “No Losses” vs. “No Gains”

“…In clinical work, particularly with veterans, it is common to hear that the most thrilling event of their lives was successfully escaping from an ambush echoing the commonly accepted psychological notion that active avoidance of punishment is reinforcing. This may not be the case for predisposed people, which could diminish their avoidance of stressful situations with heightened potential for trauma exposure to the point of helplessness, which is an essential precursor for the development of PTSD (Pivovarova et al, 2016). This causality is far from been settled, however, with consistently documented counterfactual thoughts (Erwin et al, 2018;Kelley et al, 2019) and ruminations (Blix et al, 2018;Scott et al, 2018) regarding the index trauma as features of PTSD.…”

“…There are noteworthy changes from DSM-IV TR to DSM 5 PTSD diagnostic criteria including, but not limited to the expansion of the type of incorporated symptomatology and to the deletion of a seemingly "indispensable" (Pivovarova et al, 2016) "fear, helplessness or horror" trauma response criterion (Pai et al, 2017). Consequently, in comparison to DSM-5, DSM-IV TR PTSD criteria yield a greater diagnostic sensitivity viz., fewer false negatives' rates (Schaal et al, 2015;Schnyder et al, 2015).…”