Conceptual Problems with the DSM‐IV Criteria for Posttraumatic Stress Disorder

McNally, Richard J.

doi:10.1002/9780470713570.ch1

Cited by 59 publications

(71 citation statements)

References 51 publications

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“…15 One of the most significant controversies is whether PTSD should be included in the DSM at all, with some prominent authors arguing that the disorder may be, in part, socially constructed. 16 Others however, have declared the DSM conception of PTSD to be a useful diagnostic construct, whose applicability can extend to various populations beyond that from which it was derived.…”

Section: Diagnostic and Statistical Manual Of Mental Disordersmentioning

confidence: 99%

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

Lewis

Grenyer

2009

Harvard Review of Psychiatry

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There remains controversy surrounding the nature of the relationship between borderline personality disorder and posttraumatic stress disorder, with strong arguments that it would be more accurate and less stigmatizing for the former to be considered a trauma spectrum disorder. This article reviews the major criticisms of the DSM-IV diagnosis of borderline personality disorder that have fueled this controversy, including the absence of an etiology for the disorder, which is widely believed to be associated with early traumatic experiences. Also reviewed are recent attempts to redefine the disorder as a trauma spectrum variant based on the apparent overlap in symptomatology, rates of diagnostic comorbidity, and the prevalence of early trauma in individuals with a borderline diagnosis. The conceptual and theoretical problems for these reformulations are discussed, with particular reference to discrepancies in theoretical orientation, confusion of risk with causation, and the different foci of interventions for borderline personality disorder and posttraumatic stress disorder.

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Section: Diagnostic and Statistical Manual Of Mental Disordersmentioning

confidence: 99%

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

Lewis

Grenyer

2009

Harvard Review of Psychiatry

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“…This expansion of the A1 criterion permitted the inclusion of serious illnesses such as cancer and AIDS to be considered traumatic stressors. An important change in this shift from the DSM-III-R to the DSM-IV was the fact that the notion of a stressor was broadened to incorporate the person's emotional response in addition to the traumatic event, in the form of criterion A2 (McNally, 2004). This shift permitted various events that are not necessarily outside of ordinary human experience to be considered traumatic, including physical illness.…”

Section: The Expanding Definition Of a Traumamentioning

confidence: 99%

“…it may impede the generalisation of new data to the populations in which the diagnostic criteria were originally developed. On the other hand, defining overly restrictive diagnostic criteria or limiting their clinical application in an arbitrary manner risks denying persons in need the benefit of relevant research and effective intervention (McNally, 2004).…”

Section: The Expanding Definition Of a Traumamentioning

confidence: 99%

“…In terms of the Diagnostic and Statistical Manual of Mental Disorders (3 rd edition, revised), which is the diagnostic system used by many mental health professionals, for an event to be considered a traumatic stressor it was required to be "outside the bounds of everyday experience" and of sufficient magnitude to "provoke stress in nearly everyone" (APA, 1987). Thus experiences such as war, rape, torture or confinement to a concentration camp qualified as traumatic events, while everyday stressors did not (McNally, 2004). Following the publication of the DSM-IV (APA, 1994) and the DSM-IV-TR (APA, 2000), the concept of a traumatic stressor was broadened so that experiences such as "experiencing, witnessing, or being confronted with an event or events that involved actual or threatened death or serious injury were considered traumatic" (APA, 2000).…”

Section: The Expanding Definition Of a Traumamentioning

confidence: 99%

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Theoretical Concerns in Applying the Diagnosis of PTSD to Persons With Hiv and Aids

Kagee

2014

Social Work

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“…Diagnostically, it is difficult to classify nightmares into trauma-related and unrelated categories, since personality, context and interpretive biases all shape dream experience and recall (Nielsen and Levin 2007). Neither specific content, vividness nor physiological reactivity is a reliable guide to the traumatic origins of nightmares (McNally 2004;Rhudy et al 2008). …”

Section: Conclusion: the Uses Of Nightmaresmentioning

confidence: 99%

Nightmares, Neurophenomenology and the Cultural Logic of Trauma

Kirmayer

2009

Cult Med Psychiatry

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The papers in this special section of CMP explore new terrain in the cultural shaping of traumatic experience. The authors describe nightmares occurring in association with trauma across diverse settings. The innovative ethnographic work presented in these papers circles around basic questions about dreams and nightmares. What kind of experiences are nightmares? To what extent does their function, form and content follow from the neurobiology of dreaming? Put another way, what accounts for the admixture of biology, personal experience and cultural content in dreams? More specifically, in the case of nightmares related to trauma, how much of their content follows from the neurophenomenology of dreaming, how much reflects specific trauma memories and experiences and how much is a result of the dreamer's imagination and interpretation operating either during the dream experience itself or on later recollection and recounting to others? Answers to these questions are crucial for any understanding of the potential links between dreams and trauma exposure and have clinical relevance for those seeking to understand and assist patients suffering from recurrent nightmares. The Neurophenomenology of Dreams and NightmaresNightmares are fearful or emotionally disturbing dreams, usually recalled on awakening from REM sleep. Current nosology distinguishes between idiopathic nightmares and those that are 'posttraumatic'-attributed by the dreamer or a clinical observer to trauma exposure. This attribution is usually based on the content of the dream (which can be linked to the traumatic event) or temporal contiguity.Certain aspects of the phenomenology of nightmares likely reflect the neurobiological processes of dreaming. Nightmares are associated with difficulties in regulating dysphoric emotions (Nielsen and Levin 2007;Phelps et al. 2008). Distressing dream imagery is stimulated by emotional events of the day and by sleep cognition. The dreamer works to regulate and reduce this distress by recontextualizing the dream imagery, constructing a story or sequence of shifting images that diminish the intensity of distress. This may involve bringing into play other dream actors or elements based on memories and experiences that recast the meaning of the negative imagery and reduce the emotional distress. When this

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Conceptual Problems with the DSM‐IV Criteria for Posttraumatic Stress Disorder

Cited by 59 publications

References 51 publications

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

Theoretical Concerns in Applying the Diagnosis of PTSD to Persons With Hiv and Aids

Nightmares, Neurophenomenology and the Cultural Logic of Trauma

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