Trauma and Stress: A New DSM-5 Chapter for PostTraumatic Stress Disorder
Post traumatic Stress Disorder (PTSD), previously in the DSM-IV’s Anxiety Disorders chapter, has been moved to an entirely new chapter called Trauma and Stressor Related Disorders. The changes for PTSD don’t stop there either.
The American Psychiatric Association (APA) publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Now in its fifth edition, the DSM-5 is the standard diagnostic tool for psychiatrists, health insurance companies, the pharmaceutical industry, policy makers and the legal system in the United States.
Because of its widespread use, any changes, additions or subtractions to the manual have far reaching implications and always spark debate. Released in May 2013, the APA made the most substantial changes to the manual in almost twenty years, including changes to stress related disorders.
What are the Changes and Diagnosis Criteria for PTSD in DSM-5?
Unlike many other mental disorders in the DSM-5, which are diagnosed based on the symptoms someone is experiencing, a PTSD diagnosis requires that a person be subjected to a “potentially traumatic event” and then develop certain indicators of the condition. The immediate question that follows for mental health providers, and society at large, is what’s the definition of a “potentially traumatic event”?
DSM-5 defines a traumatic event as exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
In addition, a person must experience one of the following to qualify for Posttraumatic Stress Disorder (PTSD):
- Direct exposure, being involved in the traumatic event
- Witness the event in person
- Indirect exposure, learning that a close relative or friend was exposed to trauma. If the event involved actual or threatened death, it must’ve been violent or accidental
- Repetitive or extreme indirect exposure, such as first responders working in the course of their professional duties
The inclusion of “sexual violence” in the definition is seen by many as a victory in ending the silence when it comes to reporting incidents of sexual assault. DSM-IV lumped this issue in with vague language about threats to “physical integrity,” which led to varying interpretations and confusion.
What are the symptoms of PTSD according to DSM-5?
- Self-destructive or reckless behavior
- Recurring, intrusive or involuntary memories of the traumatic event
- Nightmares about the event and sleep disturbance
- Flashbacks, lasting a brief period of time or resulting in lack of consciousness
- Prolonged and intense distress after exposure to the traumatic event
- Problems with concentration
- Irritable or aggressive behavior
A criticism of the APA’s definition of PTSD is that trauma is a personal and subjective experience. What might not be distressing for one person can be potentially traumatic for another. Defining “trauma” so that it fits into a scientific framework is a difficult proposition.
PTSD and Substance Abuse Disorders
Research suggests that up to 43 percent of people living with untreated and undiagnosed PTSD develop long-term substance abuse disorders. Alcohol and drugs are unconsciously used to dull the troubling symptoms of PTSD. Additionally, dependence issues mask any other co-occurring disorders, such as sleep disorders, depression or anxiety.
A thorough physical and psychological evaluation is essential in cases of PTSD, particularly where co-occurring disorders are concerned. Only a qualified psychiatrist can make the proper diagnosis. They can then prescribe appropriate medications and therapy, such as cognitive behavioral therapy, which has proven successful in cases of PTSD.
The APA’s revisions to PTSD in DSM-5 will continue to trigger heated discussions about this disorder, its causes and symptoms. Regardless, it’s ultimately necessary that anyone suffering from the painful symptoms of this disorder receive the medical attention they need.
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