- Admin
- #1
anthony
Founder
I am actually shocked after reading the current draft that is in final revision for publication, it is amazingly accurate compared to anything prior.
Very specific now, very little wriggle room for misdiagnosis between anxiety and trauma based diagnoses.
They have now adequately covered derealization, depersonalisation and dissociative as sub-types.
For those who still argue CPTSD is alive and well, this is the killer of that with its additional sub-types, now covering those with complex trauma comorbidities.
This really is an all-rounder that really closes a lot of holes in the diagnosis, without cutting out legitimate trauma sufferers, whilst being expanded to now cover that additional complex trauma aspect.
Bravo APA... job well done.
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Note: The following criteria apply to adults, adolescents, and children older than six. There is a Pre-school Subtype for children age six and younger (see below).
A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways:
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributed to the direct physiological effects of a substance (e.g., medication, drugs, or alcohol) or another medical condition (e.g. traumatic brain injury).
Specify if:
With Delayed Expression: if the diagnostic threshold is not exceeded until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Subtype: Posttraumatic Stress Disorder in Preschool Children
A. In children (less than age 6 years), exposure to one or more of the following events: death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:
B. Presence of one or more intrusion symptoms associated with the traumatic event(s) , beginning after the traumatic event(s) occurred:
D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by one or more of the following:
G. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.
H. The disturbance is not attributable to another medical condition.
Note: An individual can be diagnosed with both the Preschool and Dissociative Subtypes if criteria for both are met.
Subtype: Posttraumatic Stress Disorder – With Prominent Dissociative (Depersonalization/Derealization) Symptoms
The individual meets the diagnostic criteria for PTSD and in addition experiences persistent or recurrent symptoms of A1, A2, or both:
A1. Depersonalization: Experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling as though one is in a dream, sense of unreality of self or body, or time moving slowly.
A2. Derealization: Experiences of unreality of one’s surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)
B. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts, or behavior during alcohol intoxication), or another medical condition (e.g., complex partial seizures).
Note: The Dissociative and Preschool Subtypes are not mutually exclusive.
http://www.clinicaltrials.gov/ct2/show/NCT01510236?term=ptsd forum&rank=1
Very specific now, very little wriggle room for misdiagnosis between anxiety and trauma based diagnoses.
They have now adequately covered derealization, depersonalisation and dissociative as sub-types.
For those who still argue CPTSD is alive and well, this is the killer of that with its additional sub-types, now covering those with complex trauma comorbidities.
This really is an all-rounder that really closes a lot of holes in the diagnosis, without cutting out legitimate trauma sufferers, whilst being expanded to now cover that additional complex trauma aspect.
Bravo APA... job well done.
##########################################################
Note: The following criteria apply to adults, adolescents, and children older than six. There is a Pre-school Subtype for children age six and younger (see below).
A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways:
1. directly experiencing the traumatic event(s)
2. witnessing, in person, the traumatic event(s) as they occurred to others
3. learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental
4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.
B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.)
2. recurrent distressing dreams in which the content or affect of the dream is related to the event(s) (Note: In children, there may be frightening dreams without recognizable content. )
3. dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) are recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. (Note: In children, trauma-specific reenactment may occur in play.)
4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
5. marked physiological reactions to reminders of the traumatic event(s)
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by avoidance or efforts to avoid one or more of the following:1. distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
2. external reminders (i.e., people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about, or that are closely associated with, the traumatic event(s)
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred), as evidenced by two or more of the following:1. inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury, alcohol, or drugs)
2. persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” "The world is completely dangerous"). (Alternatively, this might be expressed as, e.g., “I’ve lost my soul forever,” or “My whole nervous system is permanently ruined”).
3. persistent, distorted blame of self or others about the cause or consequences of the traumatic event(s)
4. persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
5. markedly diminished interest or participation in significant activities
6. feelings of detachment or estrangement from others
7. persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:1. irritable or aggressive behavior
2. reckless or self-destructive behavior
3. hypervigilance
4. exaggerated startle response
5. problems with concentration
6. sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributed to the direct physiological effects of a substance (e.g., medication, drugs, or alcohol) or another medical condition (e.g. traumatic brain injury).
Specify if:
With Delayed Expression: if the diagnostic threshold is not exceeded until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Subtype: Posttraumatic Stress Disorder in Preschool Children
A. In children (less than age 6 years), exposure to one or more of the following events: death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:
1. directly experiencing the event(s)
2. witnessing, in person, the event(s) as they occurred to others, especially primary caregivers (Note:Witnessing does not include events that are witnessed only in electronic media, television, movies or pictures.)
3. learning that the traumatic event(s) occurred to a parent or caregiving figure;
B. Presence of one or more intrusion symptoms associated with the traumatic event(s) , beginning after the traumatic event(s) occurred:
1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note: spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.)
2. recurrent distressing dreams in which the content and/or affect of the dream is related to the traumatic event(s) (Note: it may not be possible to ascertain that the frightening content is related to the traumatic event.)
3. dissociative reactions in which the child feels or acts as if the traumatic event(s) were recurring, (such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings). Such trauma-specific re-enactment may occur in play.
4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
5. marked physiological reactions to reminders of the traumatic event(s)
One item from criterion C or D below:
C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by avoidance or efforts to avoid:1. activities, places, or physical reminders that arouse recollections of the traumatic event
2. people, conversations, or interpersonal situations that arouse recollections of the traumatic event.
D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by one or more of the following:
1. markedly diminished interest or participation in significant activities, including constriction of play
2. socially withdrawn behavior
3. persistent reduction in expression of positive emotions
E. Alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:1. irritable, angry, or aggressive behavior, including extreme temper tantrums
2. hypervigilance
3. exaggerated startle response
4. problems with concentration
5. sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)
F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.G. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.
H. The disturbance is not attributable to another medical condition.
Note: An individual can be diagnosed with both the Preschool and Dissociative Subtypes if criteria for both are met.
Subtype: Posttraumatic Stress Disorder – With Prominent Dissociative (Depersonalization/Derealization) Symptoms
The individual meets the diagnostic criteria for PTSD and in addition experiences persistent or recurrent symptoms of A1, A2, or both:
A1. Depersonalization: Experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling as though one is in a dream, sense of unreality of self or body, or time moving slowly.
A2. Derealization: Experiences of unreality of one’s surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)
B. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts, or behavior during alcohol intoxication), or another medical condition (e.g., complex partial seizures).
Note: The Dissociative and Preschool Subtypes are not mutually exclusive.
http://www.clinicaltrials.gov/ct2/show/NCT01510236?term=ptsd forum&rank=1
