Changes about “trauma’’ and ‘’stress’’ in DSM-5

DSM-5, The Diagnostic and Statistical Manual of Mental Disorders, was released at the American Psychiatric Association’s (APA) meeting in May 2013 that is the fifth major revision. In DSM-5, Posttraumatic Stress Disorder (PTSD) is no longer included in Anxiety Disorders and included in a new chapter as Trauma- and Stress¬or-Related Disorders. The Trauma-and-Stressor Related Disorders include Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Acute Stress Disorder, PTSD and Adjustment Disorders. Trauma- and Stress¬or-Related Disorders reşect the close relationship between anxiety disorders, obsessive-compulsive and dissociative disorders. DSM-5 eliminates the distinction between acute and chronic phases of PTSD. The patient must have PTSD symptoms that persist for at least 1 month after the traumatic event. The DSM-5 aimed to expand the definition of PTSD beyond the fear construct. DSM-5 draws a clear line about the traumatic event. The definition of trauma in PTSD indicates ‘’Exposure to actual or threatened death, serious injury, or sexual violence.’’ Sexual assault is specifically included. PTSD patients can be the actual victim or witness. Exposure to the trauma through electronic media, television, movies, and pictures is not considered as PTSD unless these traumatic events are work-related. There are four PTSD symptom clusters (There were three in DSM IV) a) Intrusion symptoms including dissociative reactions (dissociative reactions are şashbacks, derealization, and depersonalization.) b) avoidance symptoms c) Negative alterations in mood and cognitions (dysphoric type) d) alterations in arousal and reactivity. To satisfy the criteria for PTSD, there must be a minimum number of symptoms from each cluster: at least one of five re-experiencing symptoms, one of two avoidance symptoms, three of seven cognitions and mood symptoms, and three of six hyperarousal symptoms. The number of symptoms increased from 17 in DSM-IV to 20 in DSM-5. There are new symptoms, namely persistent negative beliefs and expectations about oneself or the world, persistent negative trauma-related emotions, and risky or reckless behaviors. Diagnostic criteria have been suitable for children and adolescents. Separate criteria have been added for children aged 6 years or younger. Thus, there is not a separate child section in DSM-5