Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
J Clin Psychiatry. 2012 Feb;73(2):e264-70. doi: 10.4088/JCP.11m07054.
The definition of the stressor criterion (DSM criterion A1) for posttraumatic stress disorder (PTSD) is hotly debated with major revisions being considered for DSM-5. We examine whether symptoms, course, and consequences of PTSD vary predictably with the type of stressful event that precipitates symptoms.
We used data from the 2009 PTSD diagnostic subsample (N = 3,013) of women from the Nurses' Health Study II. We asked respondents about exposure to stressful events that qualified under DSM-III or DSM-IV or did not qualify under DSM criterion A1. Respondents selected the event they considered worst and reported subsequent PTSD symptoms. Among participants who met all other DSM-IV PTSD criteria, we compared distress, symptom severity, duration, impairment, receipt of professional help, and 9 physical, behavioral, and psychiatric sequelae (eg, physical functioning, unemployment, depression) by precipitating event group. Various assessment tools were used to determine fulfillment of PTSD criteria B through F and to assess these 14 outcomes.
Participants with PTSD from DSM-III events reported, on average, 1 more symptom (DSM-III, mean = 11.8 symptoms; DSM-IV, mean = 10.7 [P < .001]; non-DSM, mean = 10.9 [P < .01]) and more often reported that symptoms lasted 1 year or longer compared to participants with PTSD from other groups (DSM-III vs DSM-IV, P < .01; DSM-III vs non-DSM, P < .001). However, sequelae of PTSD did not vary systematically with precipitating event type.
Results indicate the stressor criterion as defined by the DSM may not be informative in characterizing PTSD symptoms and sequelae. In the context of ongoing DSM-5 revision, these results suggest that criterion A1 could be expanded in DSM-5 without much consequence for our understanding of PTSD phenomenology. Events not considered qualifying stressors under the DSM produced PTSD as consequential as PTSD following DSM-III events, suggesting PTSD may be an aberrantly severe but nonspecific stress response syndrome.
创伤后应激障碍（PTSD）的应激源标准（DSM 标准 A1）的定义存在争议，DSM-5 正在考虑进行重大修订。我们研究了引发症状的压力事件的类型是否可预测地影响 PTSD 的症状、病程和后果。
我们使用了来自护士健康研究 II 的 2009 年 PTSD 诊断子样本（N=3013）的女性数据。我们询问了受访者是否接触过符合 DSM-III 或 DSM-IV 标准或不符合 DSM 标准 A1 的应激事件。受访者选择他们认为最糟糕的事件，并报告随后的 PTSD 症状。在符合所有其他 DSM-IV PTSD 标准的参与者中，我们比较了不同应激源分组的痛苦程度、症状严重程度、持续时间、损伤、获得专业帮助以及 9 项身体、行为和精神后遗症（例如，身体功能、失业、抑郁）。使用各种评估工具来确定 PTSD 标准 B 至 F 的满足情况，并评估这 14 项结果。
来自 DSM-III 事件的 PTSD 参与者平均报告了 1 个以上的症状（DSM-III，平均=11.8 个症状；DSM-IV，平均=10.7[P<.001]；非-DSM，平均=10.9[P<.01]），并且更经常报告症状持续 1 年或更长时间，与来自其他组的 PTSD 参与者相比（DSM-III 与 DSM-IV，P<.01；DSM-III 与非-DSM，P<.001）。然而，PTSD 的后遗症并没有与应激源类型系统地变化。
结果表明，DSM 定义的应激源标准可能无法提供有关 PTSD 症状和后遗症的信息。在 DSM-5 修订的背景下，这些结果表明，在 DSM-5 中，A1 标准可以扩大，而不会对我们对 PTSD 表现的理解产生太大影响。不符合 DSM 规定的应激源的事件产生的 PTSD 与 DSM-III 事件引起的 PTSD 一样严重，这表明 PTSD 可能是一种异常严重但非特异性的应激反应综合征。
