19 - The stressor criterion A in posttraumatic stress disorder: issues, evidence, and implications  pp. 216-226

The stressor criterion A in posttraumatic stress disorder: issues, evidence, and implications

By Bruce P. Dohrenwend

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Introduction

There has been a tendency in the more recent revisions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) and in studies of posttraumatic stress disorder (PTSD) to expand somewhat haphazardly the DSM-III formulation of Criterion A traumatic events. This formulation has evolved from events that are “outside the range of usual human experience” and that “would evoke symptoms in almost everyone” (APA 1980, p. 236), to a much wider range and variety of stressful events that many of us experience at one time or another, such as learning about the unexpected death of a loved one (APA 1994). The purpose of this chapter is to set forth how the field might develop a more rigorous Criterion A definition.

Background

During World War II, a view developed that psychological symptoms related to combat experiences were normal responses to abnormal situations and were transient unless treated in ways that increased secondary gain (e.g., Wessely 2005). A separate diagnostic category was created for these situationally specific phenomena, and combat-related psychopathology was included in gross stress reaction under transient situational personality disturbance in DSM-I (APA 1952).

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