Department of Psychiatry and Clinical Psychology, Saint George Hospital, University Medical Center, Beirut, Lebanon.
Biol Psychiatry. 2010 Sep 1;68(5):465-73. doi: 10.1016/j.biopsych.2010.04.032.
Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror.
Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys.
Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases.
Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement.
DSM-IV 创伤后应激障碍（PTSD）标准 A2（A2）的实用性存在争议：即接触潜在创伤性经历（PTE；PTSD 标准 A1）伴随着强烈的恐惧、无助或恐惧。
在世界心理健康调查中对 21 个国家的 52826 名受访者进行的社区调查中，使用综合国际诊断访谈评估了终身 DSM-IV PTSD。
在受访者报告的 28490 个代表性 PTE 中，有 37.6%符合标准 A2，这一比例高于符合其他标准（B-F；5.4%-9.6%）的比例。在存在（9.7%）而非不存在（.1%）A2 的情况下，满足 PTSD 所有其他标准的情况下，出现 PTSD 的条件患病率显著更高。然而，由于仅 1.4%符合所有其他标准但不符合 A2 的受访者，因此，当不需要 A2 进行诊断时，PTSD 的估计患病率仅略有增加（从 3.64%增加到 3.69%）。无论是否存在 A2，创伤后应激障碍都没有在持续存在或预测后果（随后的自杀意念或继发性障碍）方面存在差异。此外，由于 A2 是迄今为止 PTSD 报告最常见的症状，因此与筛查其他标准相比，对 A2 进行初步评估在快速排除大部分非病例方面效率要低得多。
从 DSM-IV 标准集中删除 A2 将降低 PTSD 诊断的复杂性，同时不会大量增加符合诊断标准的人数。因此，A2 应重新概念化为 PTSD 的风险因素，而不是诊断要求。
