The importance of the peritraumatic experience in defining traumatic stress.

Abstract

In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR; American Psychiatric Association, 2000), posttraumatic stress disorder (PTSD) Criterion A2 stipulates that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis. In considering this criterion, we describe its origins, review studies that have examined its predictive validity, and reflect on the intended purpose of the criterion and how it complements the mission of the DSM. We then assert that the predictive validity of Criterion A2 may not be an appropriate metric for evaluating its worth. We also note that the current Criterion A2 may not fully capture all the salient aspects of the traumatic stress response. To support this claim, we review empirical research showing that individuals adapt to extreme environmental events by responding in a complex and coordinated manner. This complex response set involves an individual's appraisal regarding the degree to which the event taxes his or her resources, as well as a range of other cognitions (e.g., dissociation), felt emotions (e.g., fear), physiological reactions (e.g., heart rate increase), and behaviors (e.g., tonic immobility). We provide evidence that these response components may be associated with the subsequent development of PTSD. We then describe the challenges associated with accurately assessing an individual's traumatic stress response. We conclude with a discussion of the need to consider the individual's immediate response when defining a traumatic stressor.

Posttraumatic stress disorder in DSM-5: Estimates of prevalence and symptom structure in a nonclinical sample of college students

“…Whether Criterion A1 should be limited in scope or expanded to include other types of events has been considerably debated in recent years (e.g., Brewin, Lanius, Novac, Schnyder, & Galea, 2009;Friedman et al, in press;Long & Elhai, 2009;Weathers & Keane, 2007). Whether Criterion A2 should be included at all also has been the subject of debate and research (Bovin & Marx, 2011;Friedman et al, in press).…”

Posttraumatic Stress Disorder and Cardiometabolic Disease

“…PTSD-related trauma hypermnesia relates to threat memorization; PTSD-related hyperarousal reflects hypervigilance and aggressive defense under threat, and PTSD-related avoidance behaviors may correspond to mammalian avoidance of, and withdrawal from, threats. Complex PTSD may, in part, correspond to the appeasement and, possibly, the tonic immobility stage [21,22]. …”

Sport coaches’ experiences of athlete injury: the development and regulation of guilt

“…Older conceptualisation of a traumatic event (APA, 1994) required the individual to have experienced fear, helplessness or horror at the time of one's exposure to an event involving actual or threatened serious injury, in order to qualify as having been exposed to a traumatic event. Yet this peri-traumatic emotional configuration of fear, helplessness or horror has been removed from current conceptualisations of a traumatic event because of mounting evidence that posttraumatic symptoms could also develop if a person had experienced alternative peritraumatic emotions or even emotional numbing whilst in the process of witnessing or learning about such an event (Bovin & Marx, 2001;Friedman, 2013;Hathaway, Boals, & Banks, 2011). Moreover, in the most recent conceptualisation of post-traumatic stress offered by the DSM-5, a new symptom category was created to exclusively address negative alterations in mood and cognition.…”