发展性创伤、复杂创伤后应激障碍与 DSM-5 的现行提案

Developmental trauma, complex PTSD, and the current proposal of DSM-5.

机构信息

Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

出版信息

Eur J Psychotraumatol. 2011;2. doi: 10.3402/ejpt.v2i0.5622. Epub 2011 Mar 7.

Abstract

This paper evaluates representation of clinical consequences of developmental psychological trauma in the current proposal of DSM-5. Despite intensive efforts by its proponents for two decades, it is not known yet if Complex PTSD will take a place in the final version of DSM-5. Recognition of dissociative character of several symptom dimensions and introduction of items about negative affects such as shame and guilt imply an indirect improvement toward better coverage of the consequences of developmental trauma in the existing category of PTSD. As disorders with highest prevalence of chronic traumatization in early years of life, dissociative disorders and personality disorder of borderline type are maintained as DSM-5 categories; however, recognition of a separate type of trauma-related personality disorder is unlikely. While a preschooler age variant of PTSD is under consideration, the proposed diagnosis of Developmental Trauma Disorder (child version of Complex PTSD) has not secured a place in the DSM-5 yet. We welcome considerations of subsuming Adjustment Disorders, Acute Stress Disorder, PTSD, and Dissociative Disorders under one rubric, i.e., Section of Trauma, Stress, or Event Related Disorders. Given the current conceptualization of DSM-5, this paper proposes Complex PTSD to be a subtype of the DSM-5 PTSD. Composition of a trauma-related disorders section would facilitate integration of knowledge and expertise about interrelated and overlapping consequences of trauma.

摘要

本文评估了 DSM-5 目前提案中发展性心理创伤临床后果的代表性。尽管其支持者在过去二十年中进行了深入的努力,但目前仍不清楚复杂创伤后应激障碍是否会出现在 DSM-5 的最终版本中。对几个症状维度的分离特征的认识以及对羞耻和内疚等负面情绪的项目的引入,意味着对现有创伤后应激障碍类别中发展性创伤后果的覆盖范围的间接改善。由于分离性障碍和边缘型人格障碍是一生中早年慢性创伤化的患病率最高的障碍,因此它们被保留为 DSM-5 的类别;然而,不太可能认识到一种单独的与创伤相关的人格障碍类型。虽然正在考虑创伤后应激障碍的学龄前儿童年龄变体,但发育性创伤障碍(复杂创伤后应激障碍的儿童版本)的拟议诊断尚未在 DSM-5 中获得一席之地。我们欢迎将适应障碍、急性应激障碍、创伤后应激障碍和分离性障碍归入一个类别,即创伤、应激或与事件相关的障碍部分。鉴于 DSM-5 的当前概念化,本文提出将复杂创伤后应激障碍作为 DSM-5 创伤后应激障碍的一个亚型。创伤相关障碍部分的组成将有助于整合关于创伤的相互关联和重叠后果的知识和专业知识。

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