Unintended Consequences of Changing the Definition of Posttraumatic Stress Disorder in<i>DSM</i>-<i>5</i>

Hoge, Charles W.; Yehuda, Rachel; Castro, Carl A.; McFarlane, Alexander C.; Vermetten, Eric; Jetly, Rakesh; Koenen, Karestan C.; Greenberg, Neil; Shalev, Arieh Y.; Rauch, Sheila A. M.; Marmar, Charles R.; Rothbaum, Barbara O.

doi:10.1001/jamapsychiatry.2016.0647

Cited by 101 publications

(90 citation statements)

References 27 publications

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“…However, in the revised PTSD diagnosis in DSM-5 , media exposure no longer qualifies as a traumatic event (American Psychiatric Association, 2013). Changes in the DMS-5 PTSD diagnosis have received criticism from PTSD experts (Hoge et al, 2016), and substantial evidence—including the present study's findings—indicates that indirect exposure to traumatic events, particularly terrorist attacks, can trigger PTSD symptoms and clinical diagnosis (Ahern, Galea, Resnick, & Vlahov, 2004; Comer et al, 2014, 2008; Galea et al, 2002; Hoge et al, 2016). Use of mobile devices and technology is ubiquitous among adolescents of diverse economic and demographic backgrounds (Madden, Lenhart, Duggan, Cortesi, & Gasser, 2013), so media exposure to local, national, and international terrorism will likely remain common or even increase over time.…”

Section: | Discussionmentioning

confidence: 61%

Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack

et al. 2016

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Background Disruptions in emotion regulation are a transdiagnostic risk factor for psychopathology. However, scant research has examined whether emotion regulation strategies are related to the onset of posttraumatic stress disorder (PTSD) symptoms among youths exposed to trauma. We investigated whether pretrauma emotion regulation strategies prospectively predicted PTSD symptom onset after the 2013 Boston Marathon terrorist attack among adolescents and whether these associations were moderated by the degree of exposure to media coverage of the attack. Methods A sample of 78 Boston-area adolescents (mean age =16.72 years, 65% female) who previously participated in studies assessing emotion regulation and psychopathology were recruited following the terrorist attack. Within 4 weeks of the attack, we assessed self-reported PTSD symptoms and attack-related media exposure via an online survey. We examined the association of pretrauma emotion regulation strategies with PTSD symptom onset after adjustment for pretrauma internalizing symptoms and violence exposure. Results Greater pretrauma engagement in rumination predicted onset of PTSD symptoms following the attack. Adolescents who engaged in catastrophizing also had greater PTSD symptoms postattack, but only when exposed to high levels of media coverage of the attacks; the same pattern was observed for adolescents who engaged in low levels of cognitive reappraisal. Conclusions Engagement in specific emotion regulation strategies prior to a traumatic event predicts the onset of PTSD symptoms among youths exposed to trauma, extending transdiagnostic models of emotion regulation to encompass trauma-related psychopathology in children and adolescents.

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Section: | Discussionmentioning

confidence: 61%

Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack

et al. 2016

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“…This indicated a moderate level of agreement and implies that many individuals are screening positive on one measure but not the other, and vice versa. Given the differences outlined above, and suggested difficulties with shift from the DSM-IV to the DSM-5 (Hoge et al, 2016; McFarlane, 2014), it would be prudent for more research to be conducted within UK military samples to aid clinicians, service providers and policy makers working within this field.…”

Section: Discussionmentioning

confidence: 99%

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

Murphy

Ross

Ashwick

et al. 2017

European Journal of Psychotraumatology

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Background: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment.

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“…However, as the National Center for PTSD discovered, “PCL-5 scores are not compatible with PCL for DSM-IV scores and cannot be used interchangeably” (National Center for PTSD, 2016a,b, p. 1). Hoge et al (2016) found that, based on responses to the new version, at least one-third of persons diagnosed with PTSD using the DSM-IV version do not meet criteria for PTSD according to the DSM-V definition. This change resulted in some participants in this study being diagnosed with a DSM-IV criteria and others using the DSM-V. Due to such disparity, the IES-R was relied on in this study for consistent measures across the cases.…”

Section: Methodsmentioning

confidence: 99%

Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches

Hurley¹

2018

Front. Psychol.

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The effectiveness of EMDR therapy in treating veterans diagnosed with PTSD was evaluated in this study using two treatment formats: intensive daily EMDR treatment provided twice a day during a 10-day period and a second format of one session each week. The study used archived outcome data previously collected and stored at Soldier Center. Both formats provided 18–20 treatment sessions of EMDR therapy to veterans diagnosed with PTSD that included dissociative exhibitions and moral injury issues. Questions addressed included: (1) does EMDR therapy administered twice daily ameliorate veterans’ PTSD symptoms; (2) does EMDR therapy administered twice daily provide equivalent outcome results as EMDR therapy administered weekly for 18–20 sessions; and (3) does the treatment outcome persist. The effectiveness of the weekly treatment group was also evaluated. Both groups’ results were assessed at pre-treatment, post-treatment and 1-year follow-up. The results indicated that both weekly treatment and intensive daily treatment groups produced statistically significant treatment effects (p < 0.001) that were maintained at 1-year follow-up. The10-day EMDR intensive daily treatment (EMDR therapy twice a day for 10 days) produced a similar outcome as to that of the weekly treatment with a 1-year follow-up. Results support the effectiveness of EMDR therapy when offered in both weekly treatment format as well as the intensive 10-day format on an outpatient basis. While recognizing the limitations of this study the results are significant to warrant additional research.

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Unintended Consequences of Changing the Definition of Posttraumatic Stress Disorder inDSM-5

Cited by 101 publications

References 27 publications

Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack

Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches

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