Keeping Up With The DSM-V: Critical Changes in the Diagnosis of PTSD

"identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:

  • directly experiences the traumatic event;
  • witnesses the traumatic event in person;
  • learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
  • experiences first-hand repeated or extreme exposure to aversive details of the traumatic event and not through media, pictures, television or movies unless work-related)."

(Source: http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf)

Changes to the diagnosis of Post-Traumatic Stress Disorder in the DSM-V expand the criteria set of symptoms and allow for necessity of care for previously un-diagnosable risk groups. Noticeably absent in this criteria is the previously required behavioral symptoms that are relevant to the person's response of intense fear, helplessness or horror. Previously, these required criteria in the DSM-IV made it difficult to diagnosis PTSD in first responders, as well as those who worked in trauma care. Now a stronger focus is on the behavioral symptoms that fall into four specific symptom clusters:

  • re-experiencing,
  • avoidance,
  • negative cognitions,
  • mood and
  • arousal.

Diagnosis of PTSD also is now possible within one month of the event and no longer differentiates between previous specifiers of acute and chronic. PTSD's new subsets also allow for the diagnosis of those younger than 6 years old, and the diagnosis of PTSD with prominent dissociative symptoms.

Knowledge and implementation of the new criteria sets are critical in improving treatment access and documenting treatment need. Previous prevalence rates based on the prior criteria set estimates that  3.5% of the adult population are living with PTSD, and with 57.4% receiving any form of service including health care. Using the new criteria sets in the DSM-V, the actual prevalence rate may be much higher in the general population and research is needed to survey the prevalence and treatment access of previously unidentified risk populations, including children, particularly from military families and those in foster care as well as adults who are first responders and those serving in trauma care.

Treatment course for PTSD is complex and varied with the need to integrate health issues due to the chronic stress of symptoms on health conditions as well as improving awareness, self-care and coping mechanisms. It is well documented that individuals diagnosed with PTSD also have a high comorbid risk of substance and alcohol mis-use as well as co-occurring chronic medical conditions. Cultural fit of PTSD treatment must take into consideration not only of gender and cultural issues but of sexual orientation, gender identity, migration and experiences of abrupt transitions. A critical hidden PTSD risk group is the LGBT youth who make up 20% to 40% of the homeless youth population and are extremely vulnerable to an array of victimization. However, as treatment course varies and needs to be individualized and patient-centered, certain treatment competencies are required across the service spectrum to minimize any re-traumatization due to the process of treatment engagement and access. A trauma-informed approach is needed organizationally from the first point of contact with the client. Careful selection of trauma treatment interventions must be considered from the various evidenced based approaches.

June is both PTSD Awareness Month and LGBT Pride Month.

Let's take this time to ensure we are all providing access and care to the full extent possible with the new guidelines set forth in the DSM-V. Individuals with PTSD are vulnerable to so much, from flashbacks that take them back to the moment of being a victim, to the social stigma of having an emotional disorder, the possibility of facing ongoing loss and the need to better manage chronic health conditions. Let's make sure facing access to treatment is not a barrier.