A New Definition of PTSD

Post-traumatic stress disorder (PTSD) is serious mental health condition associated with exposure to an event that overwhelms a person’s ability to cope successfully with high levels of stress. The Diagnostic and Statistical Manual of Mental Disorders, a guidebook referenced by the vast majority of America’s mental health professionals, once listed PTSD as a form of anxiety disorder. The condition now belongs to a newly created category of disorders called trauma- and stressor-related disorders. In addition, the newest edition of the Diagnostic and Statistical Manual (known by the abbreviation DSM 5) contains several changes in the criteria used to diagnose cases of PTSD.

Background Information

DSM 5 and all previous editions of the Diagnostic and Statistical Manual come from the American Psychiatric Association, an organization that acts as the representative body for practicing psychiatrists in the United States and a few additional countries. For a number of historical and scientific reasons, each new version of the DSM has become the standard frame of reference for mental illness among groups such as mental health professionals, insurance companies, pharmaceutical companies and government agencies. As a rule, the definitions for mental illness contained in the DSM change when the members of committees established within the American Psychiatric Association feel that the current state of research- and doctor-based knowledge warrants such a change. New definitions can go into a revised version of the DSM’s most recent edition, or in an entirely new edition of the manual. The newly designated DSM 5 was officially released in May 2013.

Trauma- and Stressor-Related Disorder Basics

Trauma- and stressor-related disorders is the new DSM category for mental health conditions that result from the impact of unusually traumatic events or situations, or from the impact of everyday stress. In addition to post-traumatic stress disorder, this category includes a trauma-related condition called acute stress disorder (which functions as a short-term counterpart to PTSD), a separate stress-related condition called adjustment disorder, and the childhood neglect-related conditions called reactive attachment disorder and disinhibited social engagement disorder. The American Psychiatric Association created this new category in order to emphasize the similarities between PTSD and these other disorders, and deemphasize PTSD’s relationship to panic disorder, generalized anxiety disorder and other forms of medically serious anxiety.

Previous Definition of PTSD

The now obsolete definition for post-traumatic stress disorder contained in the fourth edition of the Diagnostic and Statistical Manual (DSM IV) lists several criteria for making a diagnosis for the disorder in any given person. The first of these criteria states that an affected individual must experience some sort of exposure to an event that threatens (or seems to threaten) his or her life or the lives of others; it also states that an affected individual must have a short-term subjective response to a traumatic event such as horror, helplessness, or extreme fear. The second criterion for post-traumatic stress in DSM IV states that a person with diagnosable PTSD must somehow unwillingly re-experience a traumatic event at some later point in time; examples of this re-experiencing include nightmares, flashbacks during waking hours, and the presence of mental anguish in situations that resemble the traumatic event in some way.

The third criterion in DSM IV states that a PTSD sufferer must actively try to avoid situations that remind him or her of an originating traumatic event. He or she must also experience some sort of psychological/emotional numbing that did not exist before trauma exposure. The fourth DSM IV criterion states that a person with PTSD must experience unusual levels of heightened mental arousal that manifest in ways such as sleep disturbances, concentration problems, bouts of anger or irritability, or a persistent state of jitteriness or excessive vigilance. In order to qualify as PTSD, the conditions for the last three of the listed criteria must be met one month or more after a traumatic event occurs.

New Definition of PTSD

The new definition for post-traumatic stress disorder contained in DSM 5 keeps the basic format of the criteria listed in DSM IV, but also makes important changes to those criteria. For instance, doctors must now explicitly determine the nature of their patients’ involvement in a traumatic event (e.g., direct participation, indirect participation or remote witnessing). Whatever their level of involvement, affected individuals no longer need to have specific emotional responses in the short-term aftermath of their experiences.

The new PTSD definition also breaks down the single criterion for avoidance and numbing into two separate criteria, now known as avoidance and “persistent negative alterations in cognitions and mood.” This second criterion incorporates most of the symptoms formerly listed as numbing-related; it also includes a new emphasis on the ongoing presence of damaging, negative emotions. In addition, the DSM IV criterion for heightened mental arousal now also includes the presence of symptoms related to “aggressive behavior and reckless or self-destructive behavior.”

Apart from all of these changes, the DSM 5 definition for PTSD now reduces the number of symptoms needed to diagnose post-traumatic stress in teenagers and children. For the first time, it also allows doctors to officially diagnose the condition’s presence in children at or below age six. These changes were made to reflect the current scientific consensus, which emphasizes the differences in the ways that PTSD can manifest in children and adults.