DSM-5 and Posttraumatic Stress Disorder

Andrew P. Levin; Stuart B. Kleinman; John S. Adler

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Table 1

PTSD Criteria in DSM-IV-TR versus DSM-5

	DSM-IV TR		DSM-5
A1	The person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others.	A1	Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
			1. Directly experiencing the traumatic event(s).
			2. Witnessing, in person, the event(s) as it occurred to others.
			3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
			4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
			Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
A2	The person's response involved intense fear, helplessness, or horror.	A2	Eliminated
B	The traumatic event is persistently reexperienced in one (or more) of the following ways:	B	Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
B1	Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.	B1	Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
B2	Recurrent distressing dreams of the event.	B2	Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
B3	Acting or feeling as though the event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).	B3	Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
B4	Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.	B4	Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
B5	Physiologic reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.	B5	Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C	Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three (or more) of the following:	C	Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
C1	Efforts to avoid thoughts, feelings, or conversations associated with the trauma.	C1	Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
C2	Efforts to avoid activities, places, or people that arouse recollections of the trauma.	C2	Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
		D	Negative alterations in cognitions and mood that are associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:
C3	Inability to recall an important aspect of the trauma.	D1	Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
C7	Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).	D2	Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
		D3	Persistent distorted cognitions about the cause or consequence of the traumatic event(s) that lead the individual to blame himself/herself or others.
		D4	Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
C4	Markedly diminished interest or participation in significant activities.	D5	Markedly diminished interest or participation in significant activities.
C5	Feeling of detachment or estrangement from others.	D6	Feeling of detachment or estrangement from others.
C6	Restricted range of affect (e.g., unable to have loving feelings).	D7	Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
D	Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:	E	Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
D2	Irritability or outbursts of anger.	E1	Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
		E2	Reckless or self-destructive behavior.
D4	Hypervigilance.	E3	Hypervigilance.
D5	Exaggerated startle response.	E4	Exaggerated startle response.
D3	Difficulty concentrating.	E5	Problems with concentration.
D1	Difficulty falling or staying asleep.	E6	Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
E	Duration of the disturbance is at least one month: Acute–when the duration of symptoms is less than three months. Chronic–when symptoms last three months or more.	F	Duration of the disturbance (criteria B, C, D, and E) is more than 1 month. “Acute” and “chronic” eliminated.
F	Requires significant distress or functional impairment.	G	The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
		H	The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
	Specifiers:		With dissociative symptoms (with either depersonalization or derealization).
	With delayed onset: if onset of symptoms is at least six months after the stressor.		With delayed expression: if the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).