Australian Centre for Posttraumatic Mental Health, East Melbourne, Victoria, Australia.
Psychiatry Res. 2010 Apr 30;176(2-3):257-60. doi: 10.1016/j.psychres.2009.05.012. Epub 2010 Mar 6.
The requirement that trauma survivors experience fear, helplessness or horror (Criterion A2) as a part of their posttraumatic stress disorder (PTSD) diagnosis was introduced into DSM-IV. The imminent re-definition of PTSD in DSM-V highlights the need for empirical studies to validate the utility of the A2 requirement. We aimed to identify (i) how often A2 was associated with PTSD (B-F criteria) at 3 months after trauma and (ii) what was the peritraumatic emotional experience for those who met PTSD criteria but were A2 negative. In a prospective design cohort study we assessed the peritraumatic emotional experience of 535 injury patients in four Australian hospitals. These patients were followed up 3 months later and assessed for PTSD using a structured clinical interview. The majority of those who developed PTSD (B-F criterion) at 3 months met A2 criteria. A substantial minority, however (23%), did not meet A2 criteria. Those PTSD patients who were A2 negative fell into three groups: (i) those who experienced subthreshold levels of A2; (ii) those who experienced intense peritrauma emotional responses other than fear, helplessness or horror; and (iii) those who were amnesic to their peritrauma emotional experience. These findings do not support the inclusion of A2 as diagnostic requirement for DSM-V.
创伤后应激障碍（PTSD）诊断标准中要求创伤幸存者经历恐惧、无助或惊恐（标准 A2），这一要求是在 DSM-IV 中引入的。DSM-V 中对 PTSD 的即将重新定义强调了需要进行实证研究来验证 A2 要求的实用性。我们旨在确定：（i）在创伤后 3 个月时，A2 与 PTSD（B-F 标准）相关的频率；以及（ii）对于符合 PTSD 标准但 A2 为阴性的患者，其创伤前的情绪体验是什么。在一项前瞻性设计的队列研究中，我们评估了澳大利亚四家医院的 535 名创伤患者的创伤前情绪体验。这些患者在 3 个月后接受随访，并使用结构化临床访谈评估 PTSD。大多数在 3 个月时出现 PTSD（B-F 标准）的患者符合 A2 标准。然而，相当一部分（23%）患者不符合 A2 标准。那些 PTSD 患者 A2 为阴性的患者分为三组：（i）经历 A2 阈下水平的患者；（ii）经历强烈的创伤前情绪反应而非恐惧、无助或惊恐的患者；以及（iii）对创伤前情绪体验失忆的患者。这些发现不支持将 A2 纳入 DSM-V 的诊断要求。
