Changing the rules of PTSD

Changing the rules of PTSD
Philly.com
Jonathan Purtle, Doctoral candidate in public health. Works at Drexel's Center for Nonviolence and Social Justice
NOVEMBER 13, 2013

Last week, the International Society for Traumatic Stress Studies had its annual meeting in Philadelphia. I was there, and discussions abound about “Criterion A.” Contrary to what its name might suggest, Criterion A is not a vitamin, nor is it a short-course bicycle race. Criterion A defines the types of experiences that are considered traumatic enough to cause post-traumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Criterion A has long been a point of contention, in part because it has significant bearing on who receives a PTSD diagnosis and is eligible for evidence-based treatments covered by insurance.

There are special rules when it comes to PTSD. As opposed to most other disorders in the DSM, for which diagnoses are based on symptoms alone, PTSD requires that a person be exposed to a “potentially traumatic event” and then develop specific symptoms. Criterion A defines what counts as: 1) a potentially traumatic event, and 2) a level of exposure sufficient to cause PTSD. Last May, Criterion A was changed with along with other modifications to the PTSD diagnosis in the new DSM 5.

What are considered potentially traumatic events in the DSM 5? A potentially traumatic event is one that involves “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.” As with the previous version of the DSM(4), a serious car accident is considered a potentially traumatic event, getting laid off, while highly stressful, is not. The definition of a potentially traumatic event in the DSM 5 is quite similar to that in the DSM 4, but differs in that sexual violence is explicitly named instead of being lumped together with other threats to “physical integrity.” This change can be interpreted as a small milestone in breaking the silence about sexual violence and its consequences. Depending upon the circumstances of the event, 30%-80% of sexual assault survivors develop PTSD—a rape takes place about every six minutes in the United States.

Criterion A in the DSM 5 also states that repeated, indirect exposure to the gruesome details of potentially traumatic events can be sufficient to cause PTSD, even if the person who experienced the event was a not a loved one. This mainly applies to people working in professional capacities such as first responders, like firefighters and police, or social workers who learn about the traumas of their clients.
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