QUESTION

While the DSM-5 is considered a reputable standard for determining psychopathology, it has been criticized by some professionals in the behavioral health fields. As you study psychopathology, it is important for you to understand the varied viewpoints regarding this diagnostic tool and to be able to critique and evaluate its relevance. you will demonstrate your ability to critique the role of the DSM in determining psychopathology.

• Critique the diagnostic accuracy and cultural sensitivity of the DSM-5 diagnosis of PTSD.
• Include an analysis of the strengths and opportunities for how PTSD is characterized in the DSM-5.
• Evaluate the strengths and weaknesses of other available diagnostic systems, including their evaluation technique for PTSD.
• Review the DSM-5 for other diagnoses that contain the DSM-5 criteria for PTSD. Describe any you find.

ANSWER

Critique of the DSM-5 Diagnosis of PTSD

1. Critique of Diagnostic Accuracy and Cultural Sensitivity

In other words, the DSM-5 might have increased sensitivity and specificity for particular kinds of trauma, but it could not do justice to the heterogeneity of the course and phenomenology of PTSD that would likely be encountered in clinical practice. This is important not only to understand the disorder better at the clinical level, he added, but also to teach trainees about the richness of the disorder and to find ways to subclassify it. Advances in genetics, neuroimaging, cognitive and affective neuroscience, and more breakdown on the phenomenology of the disorder, he pointed out, might reveal different pathways to the PTSD syndrome and might support a more fine-grained categorization system. In the end, my nationality influences how I conceptualize PTSD and depression and we should be aware of this and other cultural blinders when evaluating patients. Science, after all, is not culturally bound but scientists are and we may unintentionally allow Western psychiatric constructs, such as depression and PTSD, to be assumed to be universally applicable. Scientists and experts of the disorder should be aware of the ethnically and racially diverse populations that were dealing with different forms and expressions of these disorders. These different forms might have different etiologies and might respond differently to different treatments. If science is a common language and it’s shared by many, it shows that removing PTSD from the anxiety disorders may have a bridge, but if that was only the sole rationale for moving it, now that particular critique is no longer valid. But there were substantial empirical data, both factor analysis data from the DSM IV field trials and new data from DSM-5, that ended up supporting that PTSD is not an anxiety disorder. In other words, data from clinical trials and genetic studies helped solidify the researchers’ decision to move PTSD out of the anxiety disorders. But in fact, by and large, once people learned what these criteria were, it seems to be working well enough. Even the PTSD diagnosis of the DSM-5 has been criticized, particularly through the phenomenological approach. Widiger & Coker outed inner text. The main problem has been the language of exclusion and sometimes it did stifle that PTSD could be identified, misunderstood, or was misdiagnosed because of the width and it lacked the introduction.

1.1. Accuracy of DSM-5 Diagnosis of PTSD

It is said in DSM-5 that the signs of PTSD may increase quickly in the first half a year after the trauma, but it is often the case that the full disorder is not present until six months after the trauma. It states that if a person’s symptoms go on for younger than a month, the individual has acute stress disorder; it is easier to diagnose a person with that. Nonetheless, it is evident that there are no natural boundaries at around 30 days, as many folks’ symptoms continue further than a month after the trauma. Secondly, the inability to attribute PTSD to a specific stressor – that is, a exposing to a stressor is a necessary criterion – has drawn some recent criticism (Savelev, 2013). The fifth edition argues that it is not essential to have any particular period of time between the stressor and the start of the symptoms, but individuals with prolonged duration of symptoms (i.e. over 12 months) are accorded a diagnosis of ‘chronic’ PTSD. This limits the use of diagnosis in forensic and other non-clinical settings where the clinical presentation and the determination of the onset of the disorder after a particular traumatic event may be relevant (Savelev, 2013). Moreover, using modern scanning equipment, scientists can observe the brain in action. It is unveiled that specific brain areas, such as the amygdala and the hippocampal, have been found to be smaller in some people who have lived through traumatic events like a car crash and sleep disorder. Such scientific advances have reminded clinicians that PTSD patients may have underlying brain abnormalities that have an impact on symptoms and treatment. However, DSM-5 still relies on observations from patients themselves to define disorder. Clinicians who diagnose based on DSM-5 must do so by sampling history, clinical observations and track record. Such concept is piecemeal and DSM-5 has been widely criticised for the relative impreciseness of its diagnostic criteria and PTSD is no exception.

1.2. Cultural Sensitivity in DSM-5 Diagnosis of PTSD

In the DSM-5, the diagnosticians’ “clinical significant” only turns when a certain amount of symptoms are causing “significant” disruption of the individual’s daily life. Moreover, the “duration” of symptoms for the proposal of PTSD diagnosis also becomes longer than the former diagnosis, as it has to remain for more than one month from DSM-IV-TR to six months in DSM-5. The requirement of symptoms duration may be due to two reasons from the aspect of clinical practicability. Firstly, the diagnosticians may consider the patient is just experiencing some sudden traumatic events in life and shock reactions have not completely been removed. In fact, some persons may recover from the trauma after one month’s time but, in some cases, it may not be adequate for the patient in orientating themselves back to normal life. On the other hand, it may be in help of controlling the over-diagnosis of PTSD as the PTSD symptoms may overlap with the symptoms of other mood disorders, like depression. In this case, the length prolonged symptoms display can be a minor indicator for differentiating the illness concerned. Geois & Macdonald (2009) addressed that the criteria in DSM-IV-TR “likely to capture the most severe and chronic forms of the disorder” may lead to under-diagnosis since individuals may not meet the “full” proposal of diagnosis. However, the new criteria in DSM-5 also considered many sickness levels of symptoms display will decrease under that. For example, the removal of “Foreshortened Future” may allow more PTSD diagnoses who fail to see how they can live a fulfilling life in their state may be classified under a more proper diagnosis. The proposal of symptoms quantity and quality leads to the separation of symptom clusters and it may in turn bring improvements for tailored treatments targeted on individual symptom clusters. Kassam-Adams & Winston (2010) suggested that the refinement of symptoms cluster in criterion B and C under DSM-5 all acceptably characterize modern conceptualizations of PTSD. However, the study argued that the symptom labeled under criterion D – “sense of a foreshortened future” may not seem to be a strong determinant for PTSD as previous researchers demonstrated. Although the proposed research aims for the aim of removing the limitations in the former diagnosis, due to inevitable trust in hypothesis and assumption, the revision of PTSD diagnosis in DSM-5 also caused disputes around and after the establishment.

2. Analysis of Strengths and Opportunities in Characterization

2.1. Strengths of DSM-5 in Characterizing PTSD

2.2. Opportunities for Improvement in Characterizing PTSD

3. Evaluation of Other Diagnostic Systems for PTSD

3.1. Strengths of Other Diagnostic Systems for PTSD

3.2. Weaknesses of Other Diagnostic Systems for PTSD

3.3. Evaluation Techniques in Other Diagnostic Systems for PTSD

4. Review of DSM-5 for Other Diagnoses with PTSD Criteria

4.1. Diagnoses in DSM-5 with PTSD Criteria

4.2. Description of Diagnoses with PTSD Criteria

DSM-5 And PTSD Diagnosis

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