Is DSM-IV criterion A2 associated with PTSD diagnosis and symptom severity?

Authors

  • Princess E. Osei-Bonsu,

    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
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  • Avron Spiro III,

    1. VA Boston Healthcare System, Boston, Massachusetts, USA
    2. Boston University Schools of Public Health and Medicine, Boston, Massachusetts, USA
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  • Mark R. Schultz,

    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
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  • Karen A. Ryabchenko,

    1. VA Boston Healthcare System, Boston, Massachusetts, USA
    2. Boston University School of Medicine, Boston, Massachusetts, USA
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  • Eric Smith,

    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
    2. Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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  • Lawrence Herz,

    1. MH Service Line/General Psychiatry, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
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  • Susan V. Eisen

    Corresponding author
    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
    2. Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
    • Center for Health Quality, Outcomes, and Economic Research, 200 Springs Road (152), Bedford, MA 01730.
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  • This research was supported by grant IIR 09-342 from the Veterans Administration Health Services Research & Development (HSR&D) service (Susan V. Eisen, Principal Investigator). The work was conducted at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Abstract

The diagnostic criteria for posttraumatic stress disorder (PTSD) have received significant scrutiny. Several studies have investigated the utility of Criterion A2, the subjective emotional response to a traumatic event. The American Psychiatric Association (APA) has proposed elimination of A2 from the PTSD diagnostic criteria for DSM-5; however, there is mixed support for this recommendation and few studies have examined A2 in samples at high risk for PTSD such as veterans. In the current study of 908 veterans who screened positive for a traumatic event, A2 was not significantly associated with having been told by a doctor that the veteran had PTSD. Those who endorsed A2, however, reported greater PTSD symptom severity in the 3 DSM-IV symptom clusters of reexperiencing (d = 0.45), avoidance (d = 0.61), and hyperarousal (d = 0.44), and A2 was significantly associated with PTSD symptom severity for all 3 clusters (R2 = .25, .25, and .27, respectively) even with trauma exposure in the model. Thus, although A2 may not be a necessary criterion for PTSD diagnosis, its association with PTSD symptom severity warrants further exploration of its utility.

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