According to DSM–IV, an individual’s diagnosis changes from acute stress disorder to acute PTSD if symptoms persist for more than month. After 3 months of symptoms, the diagnosis changes again to chronic PTSD.
There is evidence that a diagnosis of acute stress disorder can identify a significant proportion of people with acute trauma who go on to develop PTSD (around 80%; Harvey & Bryant, 2000). It has been argued that placing greater emphasis on re-experiencing, avoidance and arousal symptoms can further increase the predictive power of these diagnostic criteria.
However, there is considerable overlap between acute stress disorder and acute PTSD if the duration criteria are removed, and both are equally predictive of later PTSD, bringing into question the need for a separate diagnosis of acute stress disorder (Brewin et al, 2003).
Table 1 outlines the DSM–IV criteria for PTSD. The phrase ‘outside the range of usual human experience’ has now been dropped from the definition. This is in part the result of research which suggests that the perception of fear and threat is crucial in the genesis of PTSD, so that PTSD is possible after events which are common but terrifying (including road traffic accidents and domestic violence).
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Gwen Adshead and Scott Ferris
Gwen Adshead is Consultant Forensic Psychotherapist at Broadmoor Hospital (Dadd Centre, Crowthorne, Berkshire RG45 7EG, UK. Email: gwen.adshead@wlmht.nhs.uk). Her research interests include psychiatric ethics, moral reasoning in psychiatry and attachment histories in abusive parents. Scott Ferris is Specialist Registrar in Psychotherapy at Forest House, Walthamstow, London and was previously Specialist Registrar in Forensic Psychiatry working in the trauma service at St George’s Hospital, London. His other research interests include attachment and offence representations.
