Get access

Finalizing PTSD in DSM-5: Getting Here From There and Where to Go Next


  • Matthew J. Friedman

    Corresponding author
    1. National Center for PTSD, White River Junction, Vermont, USA, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
    • Correspondence concerning this article should be addressed to Matthew J. Friedman, National Center for PTSD, VA Medical Center, 215 North Main Street, White River Junction, VT 05009. E-mail:

    Search for more papers by this author

  • I would like to acknowledge the remarkable contributions of all members and advisors of the Trauma/Stressor-Related and Dissociative Disorders Sub-Work Group of the Anxiety Disorder Work Group of DSM-5. I also thank the American Psychiatric Association (APA) for all its support and single out Seung-Hee Hong, in this regard. Finally, the opinions and observations in this article are entirely my own and do not represent those of the APA, the Department of Veterans Affairs (VA), or the VA's National Center for PTSD.


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; 2013) 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.

Traditional and Simplified Chinese Abstracts by AsianSTSS


撮要:敲定精神疾病診斷和統計手冊(DSM-5;美國精神學會;2013)中創傷後壓力症(PTSD)的診斷準則是嚴謹而建基於臨床經驗的。改變任何DSM-Ⅳ診斷準則要求都有高門檻。本文詳述當中過程和理據,因而有新一章,即〝創傷和壓力相關障礙〞在DSM-5的元結構中設立。而DSM-5 PTSD準則中曾討論的特定議題包括:闊或窄的PTSD結構,對準則A的決定,其他PTSD症狀羣和區分符的支持實証,加入解離和學前子類別,在互聯網調查和DSM-5現場測試新準則的研究,加入PTSD子類別,取消複雜PTSD,和比較DSM-5與世界衛生組織即將實行的國際疾病分類(ICD-11)兩者的PTSD準則。PTSD結構不斷演變。DSM-5中,它從一個狹窄地以驚恐為本的焦慮症走到包括煩躁/快感和外在化PTSD等表型。解離子類別可能開展對複雜PTSD的新研究路向。學前子類別包括影響幼兒表現PTSD的重要發展因素。DSM-5和ICD-11在不同的方向發展,對未來研究和臨床工作方面必定有深遠影響。


撮要:敲定精神疾病诊断和统计手册(DSM-5;美国精神学会;2013)中创伤后压力症(PTSD)的诊断准则是严谨而建基于临床经验的。改变任何DSM-Ⅳ诊断准则要求都有高门坎。本文详述当中过程和理据,因而有新一章,即〝创伤和压力相关障碍〞在DSM-5的元结构中设立。而DSM-5 PTSD准则中曾讨论的特定议题包括:宽或窄的PTSD结构,对准则A的决定,其他PTSD症状羣和区分符的支持实证,加入解离和学前子类别,在互联网调查和DSM-5现场测试新准则的研究,加入PTSD子类别,取消复杂PTSD,和比较DSM-5与世界卫生组织即将实行的国际疾病分类(ICD-11)两者的PTSD准则。PTSD结构不断演变。DSM-5中,它从一个狭窄地以惊恐为本的焦虑症走到包括烦躁/快感和外在化PTSD等表型。解离子类别可能开展对复杂PTSD的新研究路向。学前子类别包括影响幼儿表现PTSD的重要发展因素。DSM-5和ICD-11在不同的方向发展,对未来研究和临床工作方面必定有深远影响。

Get access to the full text of this article