Dohrenwend B P
Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Psychol Inj Law. 2010 Jun 1;3(2):89-99. doi: 10.1007/s12207-010-9072-1.
The diagnosis of posttraumatic stress disorder (PTSD) was introduced in 1980 with the publication of the Diagnostic and Statistical Manual of the American Psychiatric Association, Third Edition (DSM-III). DSM-III put forward a novel syndrome consisting of intrusive, avoidance/numbing, and arousal symptoms as distinctive psychopathology following exposure to traumatic events. The traumatic stressors, although expanded in later editions published in 1987 (DSM-III-R) and 1994 (DSM-IV), focus on life-threatening events and situations. However, at least 12 studies, most of them recent, have found associations between the PTSD symptoms and the PTSD symptom syndrome with stressors, such as unemployment and divorce that would not qualify, even in the broadened DSM-IV diagnosis, as traumatic stressors. These findings challenge the basic assumption on which the PTSD diagnosis is based, the assumption that exposure to life-threatening stressors is the primary cause of a unique set of stress response symptoms. The purpose of this paper is to show how to confront this challenge by developing a typology of stressful situations and events that can be tested systematically for their relation to the PTSD symptom syndrome and other relevant variables. The typology includes but is not limited to the types of situations and events defined as "traumatic" in the DSMs.
创伤后应激障碍（PTSD）的诊断于1980年随着美国精神病学协会《诊断与统计手册》第三版（DSM-III）的出版而引入。DSM-III提出了一种新的综合征，由侵入性、回避/麻木和唤醒症状组成，作为暴露于创伤事件后的独特精神病理学表现。创伤性应激源虽然在1987年出版的后续版本（DSM-III-R）和1994年出版的（DSM-IV）中有所扩展，但主要集中在危及生命的事件和情况上。然而，至少有12项研究，其中大部分是近期的研究，发现PTSD症状和PTSD症状综合征与诸如失业和离婚等应激源之间存在关联，即使在扩大后的DSM-IV诊断中，这些应激源也不符合创伤性应激源的标准。这些发现挑战了PTSD诊断所基于的基本假设，即暴露于危及生命的应激源是一组独特的应激反应症状的主要原因。本文的目的是展示如何通过开发一种应激情况和事件的类型学来应对这一挑战，这种类型学可以系统地测试其与PTSD症状综合征及其他相关变量的关系。该类型学包括但不限于DSM中定义为“创伤性”的情况和事件类型。
