Finalizing PTSD in DSM-5: Getting Here From There and Where to Go Next
Finalizing PTSD in DSM-5: Getting Here From There and Where to Go Next
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DOI：
10.1002/jts.21840
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发表时间：
2013-10-01
影响因子：
3.3
通讯作者：
Friedman, Matthew J.
中科院分区：
文献类型：
--
作者：
Friedman, Matthew J.
在《精神疾病诊断和统计手册》(第5版；DSM-5；美国精神病学协会)中形成创伤后应激障碍(PTSD)诊断标准的过程是基于经验和严格的。任何DSM-IV诊断标准的任何变化都有一个很高的阈值。本文描述了这一过程。介绍了导致在DSM-5元结构内创建新的章节--创伤和应激源相关障碍--的基本原理。讨论的有关DSM-5创伤后应激障碍标准本身的具体问题包括：广义与狭义创伤后应激障碍的结构；关于标准A的决定；支持其他创伤后应激障碍症状群和指定者的证据；分离性和学龄前儿童亚型的增加；来自互联网调查和DSM-5现场试验的新标准的研究；创伤后应激障碍亚型的增加；复杂的创伤后应激障碍不包括在内；以及DSM-5与世界卫生协会即将出台的国际疾病分类(ICD-11)对创伤后应激障碍的诊断标准之间的比较。创伤后应激障碍的结构在继续发展。在DSM-5中，它已经超越了狭隘的基于恐惧的焦虑症，包括烦躁不安/缺乏快感和外在的创伤后应激障碍表型。这种游离的亚型可能为治疗复杂的创伤后应激障碍开辟新的途径。学龄前亚型包含了影响幼儿创伤后应激障碍表达的重要发育因素。最后，DSM-5和ICD-11所采取的截然不同的方法应该对今后的研究和实践产生深远影响。
The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM-IV diagnostic criterion. The process is described in this article. The rationale is presented that led to the creation of the new chapter, Trauma- and Stressor-Related Disorders, within the DSM-5 metastructure. Specific issues discussed about the DSM-5 PTSD criteria themselves include a broad versus narrow PTSD construct, the decisions regarding Criterion A, the evidence supporting other PTSD symptom clusters and specifiers, the addition of the dissociative and preschool subtypes, research on the new criteria from both Internet surveys and the DSM-5 field trials, the addition of PTSD subtypes, the noninclusion of complex PTSD, and comparisons between DSM-5 versus the World Health Association's forthcoming International Classification of Diseases (ICD-11) criteria for PTSD. The PTSD construct continues to evolve. In DSM-5, it has moved beyond a narrow fear-based anxiety disorder to include dysphoric/anhedonic and externalizing PTSD phenotypes. The dissociative subtype may open the way to a fresh approach to complex PTSD. The preschool subtype incorporates important developmental factors affecting the expression of PTSD in young children. Finally, the very different approaches taken by DSM-5 and ICD-11 should have a profound effect on future research and practice.