Reformulating PTSD forDSM‐V: Life after Criterion A

Abstract

The diagnosis of posttraumatic stress disorder has been criticized on numerous grounds, but principally for three reasons (a) the alleged pathologizing of normal events, (b) the inadequacy of Criterion A, and (c) symptom overlap with other disorders. The authors review these problems along with arguments why the diagnosis is nevertheless worth retaining in an amended form. A proposal for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is put forward that involves abolishing Criterion A, narrowing the B criteria to focus on the core phenomena of flashbacks and nightmares, and narrowing the C and D criteria to reduce overlap with other disorders. The potential advantages and disadvantages of this formulation are discussed.

A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire

“…Following the work of Brewin et al (2009), and aligned with the goal of ICD-11 to maximize clinical utility (First et al, 2015), a six-symptom model of PTSD has been proposed and widely validated (e.g. Forbes et al, 2015; Hansen, Hyland, Armour, Elklit, & Shevlin, 2015; Hyland, Brewin, & Maercker, 2017; Tay, Rees, Chen, Kareth, & Silove, 2015).…”

“…PTSD is defined by three clusters each containing two symptoms (see Brewin, Lanius, Novac, Schnyder, & Galea, 2009; Maercker et al, 2013): (1) re-experiencing of the trauma in the present (Re), (2) avoidance of traumatic reminders (Av), and (3) a persistent sense of threat that is manifested by increased arousal and hypervigilance (Th). In contrast, the definition of CPTSD includes the six PTSD symptoms as well as an additional set of symptoms that reflect ‘Disturbances in Self-Organization’ (DSO).…”

“…Consistent with these guidelines, the measurement and psychometric assessment of ICD-11 PTSD has limited each cluster to be represented by two symptoms (Brewin et al, 2009). There is an emerging consensus on the specific symptoms that describe and can be used to assess ICD-11 PTSD (Maercker et al, 2013).…”

Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel

“…This parsimonious conceptualization of PTSD aims at simplifying the assessment and at reducing over-diagnosing and false-positive comorbidities (Brewin, Lanius, Novac, Schnyder, & Galea, 2009; Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013; Maercker et al, 2013; Stein, Seedat, Iversen, & Wessely, 2007), assuming that these symptoms represent characteristics that are salient to all PTSD cases (Brewin et al, 2009; Maercker et al, 2013). Besides, the ICD-11 proposal clarifies that impairment in one area of functioning and a duration of at least one month must be reported (Maercker et al, 2013).…”

The Trauma and Life Events (TALE) checklist: development of a tool for improving routine screening in people with psychosis

“…Lifetime trauma screening measures often focus on events involving physical threats, as specified in the event criterion (‘ exposure to actual or threatened death, serious injury or sexual violation ’) in DSM-V for PTSD (American Psychiatry Association [APA], 2013). The exclusion of other types of threatening events has been questioned, given that psychologically traumatizing events, such as emotional abuse, neglect and discrimination, are associated with post-traumatic stress reactions and psychosis (Brewin, 2015; Brewin, Lanius, Novac, Schnyder, & Galea, 2009; Kelleher et al, 2013; van Dam et al, 2012). Childhood trauma screening measures, such as the Childhood Trauma Questionnaire (CTQ-SF; Bernstein et al, 2003) and the Childhood Abuse and Trauma Scale (CAT; Sanders & Becker-Lausen, 1995), include psychologically threatening events but tend to focus predominantly on familial trauma and do not routinely assess for the current significance of these events.…”