Psychological Injury and Law

, Volume 7, Issue 2, pp 93–107 | Cite as

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

  • Frank W. Weathers
  • Brian P. Marx
  • Matthew J. Friedman
  • Paula P. Schnurr
Article

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.

Keywords

DSM-5 PTSD Assessment 

References

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: AuthorGoogle Scholar
  3. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: AuthorGoogle Scholar
  4. American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: AuthorGoogle Scholar
  5. 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
  6. 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 PubMedCrossRefGoogle Scholar
  7. 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 PubMedCrossRefGoogle Scholar
  8. 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 PubMedCrossRefGoogle Scholar
  9. 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 PubMedCrossRefGoogle Scholar
  10. 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
  11. 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 PubMedCrossRefGoogle Scholar
  12. 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 PubMedCrossRefGoogle Scholar
  13. 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 PubMedCrossRefGoogle Scholar
  14. 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 PubMedCrossRefGoogle Scholar
  15. 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 CrossRefGoogle Scholar
  16. 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 PubMedCrossRefGoogle Scholar
  17. 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 PubMedCrossRefGoogle Scholar
  18. 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 PubMedCrossRefGoogle Scholar
  19. 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 PubMedCrossRefGoogle Scholar
  20. 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 PubMedCrossRefGoogle Scholar
  21. Horowitz, M. J. (1976). Stress response syndromes. New York: Jason Aronson.Google Scholar
  22. Janoff-Bulman, R. (1992). Shattered assumptions: towards a new psychology of trauma. New York: Free Press.Google Scholar
  23. 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
  24. 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 PubMedCrossRefGoogle Scholar
  25. 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 PubMedCrossRefGoogle Scholar
  26. 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 PubMedCrossRefGoogle Scholar
  27. 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.Google Scholar
  28. 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 PubMedCrossRefGoogle Scholar
  29. 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 CrossRefGoogle Scholar
  30. 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 PubMedCrossRefGoogle Scholar
  31. 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 PubMedCrossRefGoogle Scholar
  32. 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 PubMedCrossRefGoogle Scholar
  33. 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 PubMedCrossRefGoogle Scholar
  34. 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 PubMedCrossRefGoogle Scholar
  35. 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.Google Scholar
  36. McNally, R. J. (2009). Can we fix PTSD in DSM-V? Depression and Anxiety, 26, 597–600. doi:10.1002/da.20586 PubMedCrossRefGoogle Scholar
  37. 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
  38. 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 PubMedCrossRefGoogle Scholar
  39. 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
  40. 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.PubMedCrossRefGoogle Scholar
  41. 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.Google Scholar
  42. 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
  43. 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 PubMedCrossRefGoogle Scholar
  44. 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 PubMedCrossRefGoogle Scholar
  45. 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 CrossRefGoogle Scholar
  46. 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 PubMedCrossRefGoogle Scholar
  47. 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
  48. 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 PubMedCrossRefGoogle Scholar
  49. 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 PubMedCrossRefGoogle Scholar
  50. 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 CrossRefGoogle Scholar
  51. 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 PubMedCentralPubMedCrossRefGoogle Scholar
  52. 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 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Frank W. Weathers
    • 1
  • Brian P. Marx
    • 2
  • Matthew J. Friedman
    • 3
  • Paula P. Schnurr
    • 3
  1. 1.Department of PsychologyAuburn UniversityAuburnUSA
  2. 2.National Center for PTSDBoston University School of MedicineBostonUSA
  3. 3.National Center for PTSDGeisel School of Medicine at Darmouth CollegeVermontUSA

Personalised recommendations