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Wednesday, January 20, 2010

DSM-IV-TR CRITERIA FOR PTSD PART I

DSM-IV-TR CRITERIA FOR PTSD

In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of it's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).  The diagnostic criteria (Criteria A-F) are specified below.

Diagnostic criteria for PTSD include history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptoms clusters:  intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms.  A fifth criterion concerns duration of symptoms and a sixth assesses functioning.

CRITERION A:  STRESSOR

The person has been exposed to a traumatic event in which both of the following have been present:

1.  The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

2. The person's response involved intense fear, helplessness, or horror.  Note:  In children, it may be expressed instead by disorganized or agitated behavior.

CRITERION B:  INTRUSIVE RECOLLECTIONS

The traumatic event is persistently re-experienced in at least one of the following ways:

1.  Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.  Note:  in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

2.  Recurrent distressing dreams of the event.  Note:  in children, there may be frightening dreams without recognizable content.

3.  Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashbacks episodes, including those that occur upon awakening or when intoxicated).  Note:  in children, trauma-specific reenactment may occur.

4.  Intense psychological distress at exposure to internal or external cues that symbolizes or resemble an aspect of traumatic event.

5.  Physiological reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

CRITERION C:  AVOIDANT/NUMBING

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1.  Efforts to avoid thoughts, feelings, or conversations associated with the trauma.

2.  Efforts to avoid activities, places, or people that arouse recollections of the trauma.

3.  Inability to recall an important aspect of the trauma.

4.  Markedly diminished interest or participation in significant activities.

5.  Feeling detachment or estrangement from others.

6.  Restricted range of affect (e.g., unable to have loving feelings).

7.  Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).


REFERENCES

American Psychiatric Association, (2000).  Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth ed.).  Washington D.C.:  American Psychiatric Association.