Forensic implications of changes in DSM-5 criteria for responses to trauma and stress.
DSM-5 significantly changed the diagnostic criteria for Posttraumatic Stress Disorder (PTSD) relative to DSM-IV/DSM-IV-TR. These changes do not alter its basic approach to diagnosing mental disorders, which treats each disorder as a separate category. This article analyzes the strengths and weaknesses of the categorical approach, and reviews empirical evidence regarding the impact of changes within it on the ease or difficulty of receiving the PTSD diagnosis. It especially analyzes the impact of newly included symptoms that are meant to identify cases in which trauma exposure was associated with changes in more serious PTSD cases, known as Complex PTSD (C-PTSD). It proposes some effects that the changes could have on psychological injury claims. Many changes could support plaintiffs' claims while others could support defense claims. Some changes could support either. Overall, DSM-5 PTSD diagnosis is more responsive to individual differences in symptom presentations and appears able to diagnose some C-PTSD cases. The thesis throughout the article is that PTSD diagnostic accuracy could be improved further, especially for C-PTSD cases, by complementing its current exclusive reliance on behavioral symptoms that are characteristic of victims in general with assessment of the meaning that the symptoms have for individual victims. The article proposes some principles to guide interpretation of the individualized meaning of victims' symptoms, which help make the reasoning behind the interpretations explicit.
Private Practice of Psychology, Upper Montclair, NJ, United States. Electronic address: madelyn@milchman.com.
Madelyn Simring
MS
Milchman
D039721:Diagnostic and Statistical Manual of Mental Disorders; D005555:Forensic Psychiatry; D006801:Humans; D016365:Liability, Legal; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D000068099:Trauma and Stressor Related Disorders / Q000175:diagnosis* / Q000523:psychology
Behavioral symptoms; C-PTSD; Categorical diagnosis; DSM-5; PTSD; Phenomenology