Insel, M.D., Director of the USA National Institute of Mental Health, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria. And in a devastating blow to the DSM system, Thomas R. But a fundamental problem still exists…Īccording to World Psychiatry, the greatest obstacle to scientific progress is, and has been, the DSM system of diagnosis 3. DSM-5 increased the number of symptom clusters from three to four and the number of symptoms from 17 to 20. But a consensus about symptom clusters still plays an important part in any diagnosis of PTSD alongside the individual having had exposure to a requisite trauma. The DSM-5 requires direct personal exposure to stressful events, witnessing of trauma to others, and/ or indirect exposure through trauma experience of a family member or other close associate. Similarly, there are careful requirements for what qualifies as vicarious trauma. Non-immediate, non-catastrophic life-threatening illness, such as terminal cancer, no longer qualifies as trauma in this definition, regardless of how stressful or severe it is. Medically based trauma is now limited to sudden catastrophe such as waking during surgery or anaphylactic shock. It has to be an event that results in “actual or threatened death, serious injury, or sexual violence”. Not only has there to be a traumatic event as a precondition to any diagnosis of PTSD according to the DSM-5, the definition of ‘traumatic event’ is also carefully prescribed. It is the only diagnostic category in the DSM-5 that is not grouped conceptually by the types of symptoms characteristic of the disorders in it. This requirement puts PTSD in a diagnostic category that is distinctive among psychiatric disorders. Key to the change in diagnosis is the requirement to identify exposure to a stressful event rather than a diagnosis based on behavioural symptoms. This has been a controversial change in the diagnosis 2. In the DSM-5, PTSD had been moved from a category of disorders that were based in anxiety to a new diagnostic category named ‘trauma and stressor-related disorders’. The revisions in diagnostic criteria between DSM-1V and DSM-5 are important to understand. ![]() It does recognize PTSD (post-traumatic stress disorder) and has revised the definition of this disorder between edition four and edition five of the manual. I’m left with an equal number of questions, albeit different ones of how the information I present below will influence the ways in which I interact with my clients, make treatment plans and, hopefully accompany them into healthier ways of being.Īs of this date, the DSM-5 1 (the diagnostic manual for mental disorders used in the USA, and throughout much of the world) does not recognize CPTSD (Complex post-traumatic stress disorder) as a formal diagnosis. ![]() The question for me now as a clinician and an EMDR Consultant is the ‘so what?’ of this new understanding. Research into the different definitions of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) has brought fresh understanding of these terms and how they have been defined. Getting one’s head round complex subject matter and different perspectives has a satisfaction all of its own. Twenty years ago I did a PhD as a mature student and learned to embrace, and even enjoy the confusion of not knowing. That layer of complexity however, has caused me to ask many questions of both my internal and my external supervisors and it’s sent me back to the literature to find out more. It makes working with these clients challenging and often, very rewarding. ![]() I have often grappled with the complexity of the stories told, the multiple layers of trauma, the difficult symptoms in the here and now. Working with trauma has brought some very complex cases to my therapy room. ![]() And does it make a difference in terms of treatment, and should we be worried if we come across CPTSD in our clients? “It's not the person refusing to let go of the past, but the past refusing to let go of the person.” Dr Marilyn Tew, one of EMDR Gateway’s founder members, explains the difference between these two diagnoses and clears away much of the confusion around it.
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