Professional Documents
Culture Documents
Disorders in DSM-5
Matthew J. Friedman MD, PhD
National Center for PTSD
Geisel School of Medicine at
Dartmouth
Disclosures
Sources of Research Support
None
Consulting Relationship
PRN
Speakers Bureau
None
Bottom Line
1. Because a variety of clinical phenotypes are
consistent with PTSD diagnostic criteria, it can no
longer simply be considered an Anxiety Disorder
2. This is reflected in the new DSM-5 chapter:
Trauma and Stressor-Related Disorders
DSM-5: Metastructure
Neurodevelopmental Disorders
Schizophrenia Spectrum & Other Psychotic Disorders
Bipolar & Related Disorders
Depressive disorders
Anxiety Disorders
Obsessive-Compulsive, Stereotypic & Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom Disorders etc.
American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, (5th ed.). Washington, DC: Author.
Dissociative Disorders
DID, Depersonalization/Derealization, Dissociative
Amnesia, etc.
2. Traumatic nightmares *
* children may have disturbing dreams without content
related to trauma
Criterion B continues on next slide.
29
Intrusion (4)
Negative Mood (1)
Dissociative (2)
Avoidance (2)
Arousal (5)
PCBD-2
B. Since the death, at least one of the following
symptoms is experienced on more days than
not and to a clinically significant degree:
1. Persistent yearning/longing for the deceased. In
young children, yearning may be expressed in play
and behavior, including separation-reunion behavior
with caregivers.
PCBD-3
2. Intense sorrow and emotional pain because of the
death.
3. Preoccupation with the deceased person.
PCBD-4
C. Since the death, at least six of the
following symptoms (from either reactive
distress or social/identity disruption) are
experienced on more days than not and
to a clinically significant degree:
Reactive Distress to the Death
1. Marked difficulty accepting the death. In children,
this is dependent on the childs capacity to
comprehend the meaning and permanence of death.
PCBD -5
2. Feeling shocked, stunned, or emotionally numb over
the loss.
3. Difficulty with positive reminiscing about the
deceased.
4. Bitterness or anger related to the loss.
5. Maladaptive appraisals about oneself in relation to
the deceased or the death (e.g., self-blame).
PCBD-6
6. Excessive avoidance of reminders of the loss (e.g.,
avoidance of people, places, or situations
associated with the deceased; in children, this may
include avoidance of thoughts and feelings
regarding the deceased).
Social/Identity Disruption
7. A desire to die in order to be with the deceased.
PCBD-7
8. Difficulty trusting other people since the death.
9. Feeling alone or detached from other people since
the death.
PCBD-8
12. Difficulty or reluctance to pursue interests since the
loss or to plan for the future (e.g., friendships,
activities).
PCBD-9
Specify if:
With Traumatic Bereavement: Following a death that
occurred under traumatic circumstances (e.g.
homicide, suicide, disaster, or accident), there are
persistent, frequent distressing thoughts, images, or
feelings related to traumatic features of the death
(e.g., the deceaseds degree of suffering, gruesome
injury, blame of self or others for the death), including
in response to reminders of the loss.