Applying The 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.
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.
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.
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).
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