Developmental trauma, complex PTSD, and the current proposal of DSM-5

Figures & data

Table 1. Proposed changes in diagnostic criteria of PTSD in DSM-5

Target definition	Rationale of change	Proposed change
Traumatic experience (Criterion A)	Better distinction of what is traumatic	Death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the four described waysDSM-IV A2 deleted
Intrusion symptoms (Criterion B)	Distinction of depressive ruminations from traumatic memories, nurturing cultural sensitivity, underlining dissociative character of flashbacks	Re-experiencing replaced by intrusion, still five items, recollection replaced by memories, distressing dreams defined broader, recurrence replaced by dissociative reactions
Avoidance of stimuli (Criterion C)	Making exclusive focus on avoidance of subjective reactions, of behaviors, or physical or temporal reminders	Number of items diminished from seven to two, several items moved to new criterion D, reminders grouped as internal and external
Negative alterations in cognitions and mood (DSM-5 new Criterion D)	New diagnostic cluster dividing DSM-IV C criterion based on confirmatory factor analytic studies, nurturing cultural sensitivity	More specific formulation of psychogenic amnesia, expanded reformulation of fore-shortened future, self-blame regarding traumatic event emphasized; wide variety of negative emotional states besides fear, helplessness, and horror emphasized; additions pertaining to the nervous system and soul
Alterations in arousal and reactivity (Criterion E in DSM-5, D in DSM-IV)	Focus changed from angry feelings (retained in D4) to aggressive behavior, focus on reckless and self-destructive behavior	Alterations (rather than persistent arousal) emphasized, new criterion (on reckless and self-destructive behavior) added (E2)
Duration and impairment (Criteria F and G in DSM-5, E and F in DSM-IV)	No change	No change
Distinction from organic mental disorder (New Criterion H in DSM-5)	Implementation of a general rule of differential diagnosis in DSM	Substance effects or general medical condition to be ruled out