4/8/2024 0 Comments Ptsd criteria for dsm 5Under DSM-IV, to receive a PTSD diagnosis, a young child must have experienced a Criterion A trauma eliciting high levels of affect, presented with at least one re-experiencing symptom, three avoidance symptoms, two arousal symptoms, and shown impaired functioning. Studies leading up to the DSM-5 revealed that PTSD was underdiagnosed in young children (Scheeringa et al. The introduction of posttraumatic stress disorder for children 6 years and younger (PTSD-6Y) in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5 2013) is an important acknowledgement that stress responses of young children show developmental differences compared to adults. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These two models also only showed small levels of convergence with CBCL dimensions. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. Criterion related validity was established by comparing each model to a categorical rating of impairment. Convergent validity was established against the Child Behavior Checklist (CBCL). The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. The final sections of this review consider: (a) partial/subsyndromal PTSD (b) disorders of extreme stress not otherwise specified (DESNOS)/complex PTSD (c) cross- cultural factors (d) developmental factors and (e) subtypes of PTSD.A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). A new set of diagnostic criteria is proposed for DSM-5 that: (a) attempts to sharpen the A1 criterion (b) eliminates the A2 criterion (c) proposes four rather than three symptom clusters and (d) expands the scope of the B-E criteria beyond a fear-based context. It has also been shown that in addition to the fear-based symptoms emphasized in DSM-IV, traumatic exposure is also followed by dysphoric, anhedonic symptoms, aggressive/externalizing symptoms, guilt/shame symptoms, dissociative symptoms, and negative appraisals about oneself and the world. Confirmatory factor analyses suggest that the latent structure of PTSD appears to consist of four distinct symptom clusters rather than the three-cluster structure found in DSM-IV. The B (reexperiencing), C (avoidance/numbing) and D (hyperarousal) criteria are also reviewed. Empirical literature regarding the utility of the A2 criterion indicates that there is little support for keeping the A2 criterion in DSM-5. With regard to A1, the review considers: (a) whether A1 is etiologically or temporally related to the PTSD symptoms (b) whether it is possible to distinguish "traumatic" from "non-traumatic" stressors and (c) whether A1 should be eliminated from DSM-5. Most of this work has focused on Criteria A1 and A2, the two components of the A (Stressor) Criterion. This is a review of the relevant empirical literature concerning the DSM-IV-TR diagnostic criteria for PTSD.
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