The Diagnostic and Statistical Manual of Mental Disorders (DSM)

Post-Traumatic Stress Disorder

• Globally, more than 70% of adults experience a traumatic event in their lives (Shalev et al., 2017).
• PTSD denotes the most prevalent psychopathological outcome of exposure to a traumatic occurrence.
• PTSD lifetime incidence varies depending on social setting and country of dwelling (Shalev et al., 2017).
• PTSD diagnostic criteria are outlined in the DSM-5 with crucial changes from DSM-4.

Theory on the Causes

• PTSD as a stress or anxiety condition poses distinctive theoretical challenges.
• Cognitive theories’ fundamental tenet is that the nature of trauma memory is crucial to the development of PTSD.
• Individual variances in cognitive reactions to trauma might represent modifiable risk factors that are vital for timely identification and treatment of PTSD (Beierl et al., 2020).
• Clark and Ehlers’s cognitive model of PTSD helps delineate the course of the condition (Beierl et al., 2020).

Cognitive Model for PTSD

• The model creation was to explain why people fail to recover from trauma, as well as establish modifiable treatment factors.
• It notes that chronic PTSD develops when trauma victims process the traumatic occurrence in ways that posit a serious current danger (Beierl et al., 2020)
• The conceived threat has two sources mainly revealing excessive negative appraisals as well as disjointed and poorly elaborated trauma memory.
• The sources occasion to the easy cue-steered triggering of recollections.

Model…Cntd.

• The recalled memories recover without a context and preserve the original increasingly intimidating implications (Beierl et al., 2020).
• The model holds that memory features and adverse appraisals wield a reciprocal association.
• The sense of current threats motivates a series of behavioral and cognitive approaches intended to reduce the threat but maintain the indications.
• The treatment approach will involve a well-outlined path analysis of negative appraisals, trauma memory features, and unhelpful coping approaches.

Current Diagnostic Criteria

• The disorder currently belongs to the new category of trauma and stressor-related disorders.
• The patient has to fulfil criterion A.
• The DSM-5 does not regard stressful happenings that are not encompassing a direct danger to life or physical injury as trauma (American Psychiatric Association, 2013a; Pai et al., 2017).
• The individual needs to have qualifying exposure to trauma, hence the requirement
  to satisfy exposure A1-A3 (Pai et al., 2017).

Diagnostic Criteria: Cntd…

• The witnessing of trauma has to be in ‘person’ and excludes exposure through electronic media, pictures, and televisions (American Psychiatric Association, 2013a).
• The exposure to trauma forms the basis for the rest of the criteria that enshrine PTSD diagnosis.
• The PTSD indications are conditionally connected to trauma exposure.
• The diagnosis of PTSD symptoms is suitable only if the person meets criterion A (Pai et al., 2017).

Diagnosis Case Example

• The patient is a 30-year-old male presenting with recurrent negative thoughts of a motor vehicle accident.
• The patient witnessed the crash firsthand and got severe injuries that left him without one leg.
• The patient started feeling adverse alteration in mood, insistent negative emotional state, and distorted cognitions regarding the accident.
• The diagnosis of PTSD is made since the psychological symptoms commenced after the traumatic event (Pai et al., 2017)

DSM-V from DSM-VI: Considerations

• The DSM-5 benchmarks for PTSD considerably differ from those in DSM-IV.
• The DSM-5 has added avoidance as one of the required diagnostic clusters.
• The new criteria highlight negative cognitions, unlike DSM-IV (American Psychiatric Association, 2013a).
• The DSM-5 does not delineate disturbing happenings by a first response of dread, powerlessness, or horror.

Considerations: Cntd…

• The DSM-5 specifies exposure to traumatic events in either threatened death, severe injury, or sexual violence.
• The individual response measure A2 has been excluded in DSM-5 (American Psychiatric Association, 2013b).
• There are now four system groupings in DSM-5, unlike three in DSM-IV.
• The diagnostic thresholds have been dropped for youngsters and teenagers in DSM-5 (American Psychiatric Association, 2013b).

Changes in Treatment

• Treatments for PTSD comprise pharmacologic, psychological, and innovative interventions (Shalev et al., 2017).
• Trauma-focused cognitive behavioral psychotherapy is the best-backed emotional mediation for PTSD.
• Pharmacologic interventions include antipsychotics and antidepressants (Shalev et al., 2017).
• Medical treatment known as termed the stellate ganglion block (SGB) is currently a developing option.

Changes: Cntd…

• PTSD treatments have changed to innovative therapies (Shalev et al., 2017).
• Doctors now employ neurofeedback to train a patient to regulate PTSD-linked brain dysfunction.
• Transcranial magnetic stimulation is similarly applicable to alter the neural activity to dedicated brain regions.
• Treatment options are exploring the efficacy of endocannabinoid modulators to decrease adverse symptoms (Shalev et al., 2017).

Changes in the Diagnosis and Treatment Approaches

• The diagnostic change was because traumatic events are relatively frequent (Watkins et al., 2018).
• The earlier symptoms did not satisfy the criteria for what constitutes a traumatic event.
• The change in treatment approaches relies on the focus of therapy, either traumatic or non-traumatic.
• There is no evidence of specific treatment outperforming the other in PTSD treatment (Watkins et al., 2018).