The DSM-5 has made a number of important changes to the criteria of post-traumatic stress disorder, the most significant being a more specific definition of the type and nature of the exposure to a threat. Under DSM-5, post-traumatic stress disorder (PTSD) is an anxiety disorder that develops in relation to an event which creates psychological trauma in response to actual or threatened death, serious injury, or sexual violation. The exposure must involve directly experiencing the event, witnessing the event in person, learning of an actual or threatened death of a close family member or friend, or repeated first-hand, extreme exposure to the details of the event. Traumas experienced may involve war, natural disasters, car accidents, sexual abuse and/or domestic violence. A formal diagnosis of PTSD is made when the symptoms cause clinically significant distress or impairment in social and/or occupational dysfunction for a period of at least one month. The symptoms cannot be due to a medical condition, medication, or drugs or alcohol.
Under DSM-5, for those older than six years of age, PTSD includes four clusters of symptoms (APA, 2013):
•Re-experiencing the event: Recurrent memories of the event, traumatic nightmares, dissociative reactions, prolonged psychological distress
•Alterations in arousal: Aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance
•Avoidance: Distressing memories, thoughts, or reminders of the event.
•Negative alterations in cognition and mood: Persistent negative beliefs, distorted blame, or trauma-related emotions; feelings of alienation and diminished interest in life
DSM-5 has established two subtypes of PTSD:
1. PTSD Preschool subtype is used in the diagnosis of children younger than 6 years of age. The diagnostic thresholds are lowered for children and adolescents.
2. PTSD Dissociative Subtype is used when the person has prominent dissociative symptoms. These dissociative symptoms include depersonalization, in which the person feels like an outside observer or detached from oneself; and derealisation, in which the world seems unreal, distant or distorted. All other criteria of PTSD must also be met.
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