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Pr Robert Ursano: Trauma and Stress Disorders in DSM-5

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Trauma and Stress-Related and Dissociative Disorders in DSM-5

Prof Robert Ursano, Bethesda



So acute stress disorder in the DSM-IV was designed for several elements. The first was that we have a time-gap in being able to classify people exposed to trauma, since PTSD can only be diagnosed after 30 days. We have this time of the first 30 days in which individuals might be highly disturbed and might need treatment. We needed a way to classify them. Secondly, there was a belief at that time that dissociative symptoms were very prominent and during that early response, the understanding was that perhaps that dissociative symptoms might help classify those early responses in the individuals that need to be treated versus those who didn’t. So there is a substantial focus in DSM-IV and dissociative disorders as a major part in the early response to trauma related disorders.

It didn’t turn out that dissociative disorders or dissociative symptoms were the primary predictors of those who get PTSD. Dissociative symptoms certainly occur, but so do many other symptoms and actually sleep disturbing is perhaps the most common.



In DSM-IV, dissociative symptoms were required prior the diagnosis, that’s no longer true in DSM-5. Secondly was we recognize that the symptoms were not well structured during the early period of time. So we no longer have the distribution requirements : you have these two of these, three of those, five of these. Rather you have the total of nine out of 14 symptoms to have acute stress disorder. We maintain the 30-day period of time which it ocured and an A1 criteria is the same as in PTSD, as it was in DSM-IV. And in DSM-5, we also dropped the A2 criteria as did PTSD in DSM-5. And those elements recognize the need for a diagnosis without requiring that they include dissociation and recognizing that we don’t yet have the ability to predict people early on as those who would have the chronic form types of problems




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