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Examining New PTSD Diagnosis Criteria


  • Published: 2012-09-06 : Author: Boston University Medical Center
  • Synopsis: Study indicates proposed changes to the diagnosis of post-traumatic stress disorder will not substantially affect number of people who meet criteria for the disorder.

Results of a study led by researchers at Boston University School of Medicine (BUSM) and the Veterans Affairs (VA) Boston Healthcare System indicate that the proposed changes to the diagnosis of post-traumatic stress disorder (PTSD) will not substantially affect the number of people who meet criteria for the disorder.

Post Traumatic Stress Disorder - PTSD is a potentially debilitating anxiety disorder triggered by exposure to a traumatic experience such as an interpersonal event like physical or sexual assault, exposure to disaster or accidents, combat or witnessing a traumatic event. There are three main clusters of symptoms: firstly, those related to re-experiencing the event; secondly, those related to avoidance and arousal; and thirdly, the distress and impairment caused by the first two symptom clusters.

Mark W. Miller, PhD, associate professor at BUSM and a clinical research psychologist at the National Center for PTSD at VA Boston Healthcare System served as lead author of the study, which is published online in Psychological Trauma: Theory, Research, Practice and Policy.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook that defines psychiatric disorders, has been undergoing revisions for the past decade in advance of the publication of its fifth edition (DSM-5). Included in the proposed revisions are the first major changes to the PTSD diagnosis since its initial appearance in DSM-III back in 1980. These include the addition of new symptoms, revision of existing ones and a new set of diagnostic criteria.

According to DSM-IV, the criteria for a diagnosis of PTSD include exposure to a traumatic event, persistent re-experiencing of the traumatic event, avoidance and emotional numbing, and persistent hyperarousal and hyper-vigilance. The proposed revisions for DSM-5 involve clarification regarding what constitutes a traumatic event, the addition symptoms such as self-destructive behavior and distorted blaming of oneself or others for the traumatic event and a reorganization of the diagnostic decision rules for establishing a diagnosis of PTSD.

Critics have raised concerns about the revision process, noting that some of the new symptoms are not unique to PTSD.

They believe that the proposed changes could lead to a number of misdiagnoses, which could artificially increase the number of patients with the disorder.

To address this and to collect data to inform final decisions about the PTSD revision, research was initiated by the DSM-5 PTSD work-group to see if these changes would affect the number of people diagnosed with PTSD. The researchers surveyed a nationally representative sample of 2,953 American adults and a second sample of 345 U.S. military veterans. They found that most of the proposed symptom changes were supported by statistical analysis and did not substantially affect the number of people who would meet criteria for the disorder. Based in part on these findings, the work-group responsible for the PTSD revisions are now moving forward with the proposed revisions for DSM-5.

This research was funded primarily by the U.S. Department of Veterans Affairs Mental Health Service and the American Psychiatric Association DSM Research Program.

The study was done in collaboration with Medical University of South Carolina, National Center for PTSD at White River Junction VA Medical Center, Dartmouth Medical School and New England Research Institutes. Other BUSM research collaborators include: Erika J. Wolf, PhD, assistant professor of psychiatry at BUSM and researcher at the National Center for PTSD at VA Boston Healthcare System; Terence Keane, PhD, professor and vice chairman of psychiatry at BUSM and director of the Behavioral Science Division of the National Center for PTSD and associate chief of staff for Research and Development at VA Boston Healthcare System; Brian P. Marx, PhD, professor of psychiatry at BUSM and researcher at the National Center for PTSD at VA Boston Healthcare System; and Darren W. Holowka, PhD, research assistant professor in psychiatry at BUSM and researcher at the National Center for PTSD at VA Boston Healthcare System.

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