Skip to main content

Advertisement

SpringerLink
Log in

Posttraumatic Stress Disorder in DSM-5: New Criteria, New Measures, and Implications for Assessment

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

The diagnostic criteria for posttraumatic stress disorder (PTSD) were substantially revised for Diagnostic and Statistical Manual of Mental Disorders—5th edition (DSM-5). This in turn necessitated revision of DSM-correspondent assessment measures of PTSD. We describe the various changes to the PTSD diagnostic criteria and the corresponding changes to National Center for PTSD measures. We also discuss the implications of the new criteria for assessment of trauma exposure and PTSD. Although the DSM-5 version of PTSD departs significantly in some respects from previous versions, we conclude that there is fundamental continuity with the original DSM-III conceptualization of PTSD as a chronic, debilitating mental disorder that develops in response to catastrophic life events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author

  • American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8, 75–90. doi:10.1002/jts.2490080106

  • Breslau, N., & Alvarado, G. F. (2007). The clinical significance criterion in DSM-IV post-traumatic stress disorder. Psychological Medicine, 37, 1437–1444. doi:10.1017/S0033291707000426

    Article  PubMed  Google Scholar 

  • Breslau, N., & Kessler, R. C. (2001). The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation. Biological Psychiatry, 50, 699–704. doi:10.1016/S0006-3223(01)01167-2

    Article  PubMed  Google Scholar 

  • Brewin, C. R. (2013). “I wouldn’t start from here”—an alternative perspective on PTSD from the ICD-11: comment on Friedman (2013). Journal of Traumatic Stress, 26, 557–559. doi:10.1002/jts.21843

    Article  PubMed  Google Scholar 

  • Brewin, C. R., Lanius, R. A., Novac, A., Schnyder, U., & Galea, S. (2009). Reformulating PTSD for DSM-V: life after Criterion A. Journal of Traumatic Stress, 22, 366–373. doi:10.1002/jts.20443

    Article  PubMed  Google Scholar 

  • Calhoun, P. S., Hertzberg, J. S., Kirby, A. C., Dennis, M. F., Hair, L. P., Dedert, E. A., & Beckham, J. C. (2012). The effect of draft DSM-V criteria on posttraumatic stress disorder prevalence. Depression and Anxiety, 29, 1032–1042. doi:10.1002/da.22012

  • Davidson, J. R. T., & Foa, E. B. (1991). Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV. Journal of Abnormal Psychology, 100, 346–355. doi:10.1037/0021-843X.100.3.346

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011). Evidence for a unique PTSD construct represented by PTSD’s D1-D3 symptoms. Journal of Anxiety Disorders, 25, 340–345. doi:10.1016/j.janxdis.2010.10.007

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Miller, M. E., Ford, J. D., Biehn, T. L., Palmieri, P. A., & Frueh, B. C. (2012). Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. Journal of Anxiety Disorders, 26, 58–64. doi:10.1016/j.janxdis.2011.08.013

    Article  PubMed  Google Scholar 

  • Elhai, J. D., & Palmieri, P. A. (2011). The factor structure of posttraumaticstress disorder: a literature update, critique of methodology, and agenda for future research. Journal of Anxiety Disorders, 25, 849–854. doi:10.1016/j.janxdis.2011.04.007

    Article  PubMed  Google Scholar 

  • Foa, E. B., Skeketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behaviour Therapy, 20, 155–176. doi:10.1016/S0005-7894(89)80067-X

    Article  Google Scholar 

  • Friedman, M. J. (2013a). Finalizing PTSD in DSM-5: getting here from there and where to go next. Journal of Traumatic Stress, 26, 548–556. doi:10.1002/jts.21840

    Article  PubMed  Google Scholar 

  • Friedman, M. J. (2013b). PTSD in the DSM-5: Reply to Brewin (2013), Kilpatrick (2013), and Maercker and Perkonigg (2013). Journal of Traumatic Stress, 26, 567–569. doi:10.1002/jts.21847

    Article  PubMed  Google Scholar 

  • Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011a). Considering PTSD for DSM-5. Depression and Anxiety, 28, 750–769. doi:10.1002/da.20767

    Article  PubMed  Google Scholar 

  • Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D. (2011b). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety, 28, 737–749. doi:10.1002/da.20845

    Article  PubMed  Google Scholar 

  • Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the Life Events Checklist. Assessment, 11, 330–341. doi:10.1177/1073191104269954

    Article  PubMed  Google Scholar 

  • Horowitz, M. J. (1976). Stress response syndromes. New York: Jason Aronson.

    Google Scholar 

  • Janoff-Bulman, R. (1992). Shattered assumptions: towards a new psychology of trauma. New York: Free Press.

    Google Scholar 

  • Keane, T. M., Fairbank, J. A., Caddell, J. M., Zimering, R. T., & Bender, M. E. (1985). A behavioral approach to the assessment and treatment of post-traumatic stress disorder in Vietnam veterans. In C. R. Figley (Ed.), Trauma and its wake (Vol. I): The study and treatment of post-traumatic stress disorder (pp. 257–294). New York: Brunner/Mazel.

    Google Scholar 

  • Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85–90. doi:10.1037/0022-006X.56.1.85

    Article  PubMed  Google Scholar 

  • Kilpatrick, D. G. (2013). The DSM-5 got PTSD right: comment on Friedman (2013). Journal of Traumatic Stress, 26, 563–566. doi:10.1002/jts.21844

    Article  PubMed  Google Scholar 

  • Kilpatrick, D. G., Resnick, H. S., & Acierno, R. (2009). Should PTSD Criterion A be retained? Journal of Traumatic Stress, 22, 374–383. doi:10.1002/jts.20436

    Article  PubMed  Google Scholar 

  • Kilpatrick, D. G., Resnick, H. S., Freedy, J. R., Pelcovitz, D., Resick, P., Roth, S., & Van der Kolk, B. A. (1998). Posttraumatic stress disorder field trial: evaluation of the PTSD construct—Criteria A through E. In A. Widiger, H. Frances, & R. Ross (Eds.), DSM-IV Sourcebook (Vol. 4, pp. 803–844). Washington, DC: American Psychiatric Press.

  • Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537–547. doi:10.1002/jts.21848

    Article  PubMed  Google Scholar 

  • King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90–96. doi:10.1037/1040-3590.10.2.90

    Article  Google Scholar 

  • Lanius, R. A., Brand, B. B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29, 701–708. doi:10.1002/da.21889

    Article  PubMed  Google Scholar 

  • Litz, B. T., & Gray, M. J. (2002). Emotional numbing in posttraumatic stress disorder: current and future research directions. Australian and New Zealand Journal of Psychiatry, 36, 198–204. doi:10.1046/j.1440-1614.2002.01002.x

    Article  PubMed  Google Scholar 

  • Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M., van Ommeren, M., et al. (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet, 381, 1683–1685. doi:10.1016/S0140-6736(12)62191-6

    Article  PubMed  Google Scholar 

  • McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD Checklist: a critical review. Clinical Psychology Review, 30, 976–987. doi:10.1016/j.cpr.2010.06.012

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252. doi:10.1146/annurev.psych.54.101601.145112

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2004). Conceptual problems with the DSM-IV criteria for posttraumatic stress disorder. In G. M. Rosen (Ed.), Posttraumatic stress disorder: Issues and controversies (pp. 1–14). New York: Wiley.

  • McNally, R. J. (2009). Can we fix PTSD in DSM-V? Depression and Anxiety, 26, 597–600. doi:10.1002/da.20586

    Article  PubMed  Google Scholar 

  • Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59–70. doi:10.1176/appi.ajp.2012.12070999

  • Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748–756. doi:10.1037/0022-006X.60.5.748

    Article  PubMed  Google Scholar 

  • Resick, P. A., & Miller, M. W. (2009). Posttraumatic stress disorder: Anxiety or traumatic stress disorder? Journal of Traumatic Stress, 22, 384–390. doi:10.1002/jts.20437

  • Rodriguez, P., Holowka, D. W., & Marx, B. P. (2012). Assessing functional impairment related to posttraumatic stress disorder. Journal of Rehabilitation Research and Development, 49, 649–666.

    Article  PubMed  Google Scholar 

  • Rogers R., Sewell, K.W., & Gillard, N.D. (2010) Structured Interview of Reported Symptoms-2 (SIRS-2) and Professional Manual. Lutz, FL: Psychological Assessment Resources.

  • Rosen, G. M. (2004). Traumatic events, criterion creep, and the creation of pretraumatic stress disorder. Scientific Review of Mental Health Practice, 3, 39–42.

    Google Scholar 

  • Rosen, G. M., & Lilienfeld, S. O. (2008). Posttraumatic stress disorder: an empirical evaluation of core assumptions. Clinical Psychology Review, 28, 837–868. doi:10.1016/j.cpr.2007.12.002

    Article  PubMed  Google Scholar 

  • Rosen, G. M., Lilienfeld, S. O., Frueh, B. C., McHugh, P. R., & Spitzer, R. L. (2010). Reflections on PTSD’s future in DSM-V. British Journal of Psychiatry, 197, 343–344. doi:10.1192/bjp.bp.110.079699

    Article  PubMed  Google Scholar 

  • Schnurr, P. P., Spiro, A., Vielhauer, M. J., Findler, M. N., & Hamblen, J. L. (2002). Trauma in the lives of older men: findings from the Normative Aging Study. Journal of Clinical Geropsychology, 8, 175–187. doi:10.1023/A:1015992110544

    Article  Google Scholar 

  • Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647. doi:10.1037/0021-843X.111.4.637

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., First, M. B., & Wakefield, J. C. (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders, 21, 233–241. doi:10.1016/j.janxdis.2006.09.006

  • Weathers, F. W., & Keane, T. M. (2007). The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma. Journal of Traumatic Stress, 20, 107–121. doi:10.1002/jts.20210

    Article  PubMed  Google Scholar 

  • Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-Administered PTSD Scale: a review of the first ten years of research. Depression and Anxiety, 13, 132–156. doi:10.1002/da.1029

    Article  PubMed  Google Scholar 

  • Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychological Assessment, 11, 124–133. doi:10.1037/1040-3590.11.2.124

    Article  Google Scholar 

  • Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596–606. doi:10.1002/da.20837

    Article  PubMed Central  PubMed  Google Scholar 

  • Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119, 764–776. doi:10.1037/a0020981

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL, 36830, USA

    Frank W. Weathers

  2. National Center for PTSD, Boston University School of Medicine, VA Boston Healthcare System, Boston, MA, USA

    Brian P. Marx

  3. National Center for PTSD, Geisel School of Medicine at Darmouth College, White River Junction, Vermont, USA

    Matthew J. Friedman & Paula P. Schnurr

Authors
  1. Frank W. Weathers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian P. Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paula P. Schnurr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frank W. Weathers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weathers, F.W., Marx, B.P., Friedman, M.J. et al. Posttraumatic Stress Disorder in DSM-5: New Criteria, New Measures, and Implications for Assessment. Psychol. Inj. and Law 7, 93–107 (2014). https://doi.org/10.1007/s12207-014-9191-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-014-9191-1

Keywords

Search

Navigation