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The Evolution of a Diagnosis: PTSD, Part Deux

Childhood should be carefree, playing in the sun; not living a nightmare in the darkness of the soul.
Dave Pelzer

Note: This is the second part of a series on the evolution of the diagnosis called Posttraumatic Stress Disorder or PTSD. While it’s not necessary to have read the first part, it may be helpful in giving you some context and an understanding of the terms used here.

One of the significant changes in the DSM-5®’s criteria to meet the diagnosis of PTSD has to do with the age of the person in question. Specifically, the authors have: (a) singled out children of age six or younger and (b) changed the criteria (the set of relevant symptoms) for those children ever so slightly. Such children don’t need to have quite as many symptoms as people older than six. This seems mildly interesting to me in a positive way. But my attention really gets drawn to the fact that the authors single out criteria for younger children at all. Let’s call this “the good news.”

Next, let’s look back at the DSM-IV® (after all, this is about evolution, right?). It stated that PTSD “can occur at any age, including childhood.” This seems like a good thing to say. However, they really don’t talk about specific age so much, so we really don’t know what “childhood” includes. Plus, they pretty much pay only lip service to children from there on. To me, this almost makes it seem like PTSD happens mostly with adults. Or at least that’s the impression I got. So, the focus on children in the DSM-5® seems like a good thing. OK, now for the not-so-good news.

Moving forward in time, we have new wisdom in the DSM-5®. There, the authors state something similar to the DSM-IV® but also quite different. They say that PTSD “can occur at any age (so far, so good), beginning after the first year of life (d’oh!). OK, what the what? While I don’t know where the authors came up with the distinction about being six years old or less, I really don’t know where they came up with the whole one-year-old thing. But, they must know what they’re talking about. After all, they took 947 pages to tell us all about their wisdom.

Well, I like to end things on a high note. So, let’s get back to the attention paid to young children. It’s like the authors gave them permission to have PTSD too and thus recognize that they might need some help as well. Yay!

Spoiler alert! The next part of this series focuses on something called “risk factors” for PTSD, which get spelled out in the DSM-5® while having been almost ignored in the DSM-IV®. Stay tuned! More good news!

DSM, DSM-IV, DSM-V, and Diagnostic and Statistical Manual of Mental Disorders are registered trademarks of the American Psychiatric Association.

Copyright 2014 Daniel J. Metevier

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