Disqualified qualifiers: evaluating the utility of the revised DSM-5 definition of potentially traumatic events among area youth following the Boston marathon bombing

Abstract

Background The DSM-5 includes a revised definition of the experiences that qualify as potentially traumatic events. This revised definition now offers a clearer and more exclusive definition of what qualifies as a traumatic exposure, but little is known about the revision’s applicability to youth populations. The present study evaluated the predictive utility of the revised DSM definitional boundaries of traumatic exposure in a sample of youth exposed to the 2013 Boston Marathon bombing and related events. Methods Caregivers (N = 460) completed surveys 2 to 6 months post bombing about youth experiences during the events and youth posttraumatic stress (PTS) symptoms. Results Experiencing DSM-5 qualifying traumatic events (DSM-5 QTEs) significantly predicted child PTS symptoms (PTSS), whereas DSM-5 non-qualifying stressful experiences (DSM-5 Non-QSEs) did not after accounting for DSM-5 QTEs. Importantly, child age moderated the relationship between DSM-5 QTEs and PTSS such that children 7 and older who experienced DSM-5 QTEs showed greater post-bombing PTSS, whereas there was no such relationship in children ages 6 and below. Conclusions Data largely support the revised PTSD definition of QTEs in older youth, and also highlight the need for further refinement of the QTE definition for children ages 6 and below.

Trauma and child psychopathology: From risk and resilience to evidence-based intervention.

“…There is now considerable evidence from large child samples supporting this current definition of a qualifying traumatic event for diagnosis of PTSD (e.g., Chou et al, 2016). There is also evidence that the current definition of a qualifying traumatic experience for PTSD requires further modification for children under the age of 6 (Chou et al, 2016).…”

“…There is now considerable evidence from large child samples supporting this current definition of a qualifying traumatic event for diagnosis of PTSD (e.g., Chou et al, 2016). There is also evidence that the current definition of a qualifying traumatic experience for PTSD requires further modification for children under the age of 6 (Chou et al, 2016). For example, media-based contact with traumatic events have been associated with PTSD symptoms in many children (Busso et al, 2014;Comer, DeSerisy, & Green, 2016;Comer & Kendall, 2007;Duarte et al, 2011), and it has been suggested that children at early stages of cognitive development may not readily distinguish between televised and real in-person events.…”

“…What experiences, when accompanied by PTSD symptoms, qualify for diagnosis of PTSD? Although the general concept of a PTSD-like syndrome has been described for centuries under various names (e.g., railway spine, soldier's heart, shellshock, battered woman syndrome; Chou et al, 2016;Friedman et al, 2011;Luz et al, 2011), the precise definitional boundaries of the disorder have shifted across taxonomies and DSM iterations. Though various DSM iterations agree that diagnostic criteria for PTSD include exposure to a traumatic event and associated cognitive, behavioral, and arousal symptoms, the optimal definition of a qualifying "traumatic exposure" has been a source of spirited debate (Weathers & Keane, 2007).…”