title: Should A2 be a diagnostic requirement for posttraumatic stress disorder in DSM-V?
abstract: The requirement that trauma survivors experience fear, helplessness or horror (Criterion A2) as a part of their posttraumatic stress disorder (PTSD) diagnosis was introduced into DSM-IV. The imminent re-definition of PTSD in DSM-V highlights the need for empirical studies to validate the utility of the A2 requirement. We aimed to identify (i) how often A2 was associated with PTSD (B-F criteria) at 3 months after trauma and (ii) what was the peritraumatic emotional experience for those who met PTSD criteria but were A2 negative. In a prospective design cohort study we assessed the peritraumatic emotional experience of 535 injury patients in four Australian hospitals. These patients were followed up 3 months later and assessed for PTSD using a structured clinical interview. The majority of those who developed PTSD (B-F criterion) at 3 months met A2 criteria. A substantial minority, however (23%), did not meet A2 criteria. Those PTSD patients who were A2 negative fell into three groups: (i) those who experienced subthreshold levels of A2; (ii) those who experienced intense peritrauma emotional responses other than fear, helplessness or horror; and (iii) those who were amnesic to their peritrauma emotional experience. These findings do not support the inclusion of A2 as diagnostic requirement for DSM-V.
authors.affiliation: Australian Centre for Posttraumatic Mental Health, East Melbourne, Victoria, Australia. mod@unimelb.edu.au
authors.forename: Meaghan L
authors.initials: ML
authors.lastname: O'Donnell
authors.forename: Mark
authors.initials: M
authors.lastname: Creamer
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006380:Helplessness, Learned; D006801:Humans; D008297:Male; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*