Der Nervenarzt

, Volume 85, Issue 5, pp 553–563 | Cite as

Trauma- und stressorbezogene Störungen

Diagnostische Konzeptualisierung im DSM-5
Leitthema

Zusammenfassung

Das DSM (Diagnostic and Statistical Manual of Mental Disorders) -5 berücksichtigt eine von der Gruppe der Angststörungen separate trauma- und stressorbezogene Störungsgruppe. Für den Versorgungsbereich der Erwachsenenpsychiatrie werden einerseits die posttraumatische Belastungsstörung (PTSD) und die akute Belastungsstörung (ASD), andererseits die Anpassungsstörungen aufgeführt. Eine strengere Fassung des Traumakriteriums fokussiert auf akute Lebensbedrohung, schwerwiegende körperliche Verletzung und sexuelle Gewalt. Direkte Konfrontation, Zeugenschaft und indirekte Konfrontation werden unterschieden, letztere aber auf gewaltsame oder unfallbedingte Traumata von nahen Familienmitgliedern oder Freunden eingeengt. Personen, die durch ihren speziellen professionellen Ersteinsatz mit den Folgen extremer Traumata indirekt konfrontiert sind, werden in ihrem speziellen PTSD-Risiko anerkannt. Das im DSM-IV enthaltene A2-Traumakriterium wird aufgegeben. Eine breite klinische PTSD-Phänomenologie enthält ein neues Cluster anhaltender Veränderungen in negativen Kognitionen und Emotionen infolge der Traumatisierung. Die ASD zielt nicht mehr darauf, eine spezielle Risikogruppe für ein späteres PTSD-Risiko zu identifizieren, sondern ein intensives Stresssyndrom mit hoher akuter Behandlungsbedürftigkeit zu definieren. Anpassungsstörungen zeichnen sich weiterhin durch eine im Vergleich zur sozialen und kulturellen Norm maladaptive Auseinandersetzung mit unspezifischen, nichttraumatischen Stressoren aus. Sowohl komplexe PTSD als auch anhaltende Trauerstörung besitzen im DSM-5 keinen eigenständigen diagnostischen Status. DSM-5 und künftige ICD-11 werden in der Konzeptualisierung stressbezogener Störungen große Unterschiede aufweisen.

Schlüsselwörter

DSM-5 Posttraumatische Belastungsstörung Akute Belastungsstörung Anpassungsstörung ICD-11 

Trauma and stressor-related disorders

Diagnostic conceptualization in DSM-5

Summary

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) includes a distinct diagnostic group of trauma and stressor-related disorders that has been set apart from anxiety disorders. From a perspective of adult psychiatry this new disorder category includes posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders. The PTSD is based on narrower trauma criteria that focus on acute life-threatening situations, serious injury, or sexual violence by way of direct confrontation, witnessing or indirect confrontation. Indirect confrontation, however, is reserved only for violent or accidental events that occurred to close family members or friends. The former A2 criterion of an intense emotional reaction to trauma has been removed. A deliberately broad approach to clinical PTSD phenomenology has created an empirically driven new cluster of persistent negative alterations in cognition and mood due to experiencing traumatic events. The ASD has been reconceptualized as an intense stress syndrome with a clear need of acute treatment during the early course after traumatic exposure. Adjustment disorders continue to emphasize maladaptive emotional and behavioral responses to unspecific, non-traumatic stressors in an intensity that is beyond social or cultural norms. Neither complex PTSD nor prolonged grief disorders have received an independent diagnostic status within DSM-5. With respect to stress-related disorders major divergences between DSM-5 and the future International Classification of Diseases 11 (ICD-11) are to be expected.

Keywords

DSM-5 Posttraumatic stress disorder Acute stress disorder Adjustment disorder ICD-11 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für PsychiatrieMedizinische Universität GrazGrazÖsterreich

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