The Altshuler Center for Education & Research at Metrocare Services and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Psychol Med. 2020 Jul;50(9):1556-1562. doi: 10.1017/S0033291719001569. Epub 2019 Jul 1.
In the nearly a quarter of a century since the addition of the clinically significant distress/impairment criterion to the definition of PTSD in DSM-IV, little research has been done to examine the association of this criterion with symptom group criteria and with the numbing subgroup specifically. This study was conducted to examine these relationships in a large database of disaster survivors consistently studied across 12 different incidents of the full range of disaster typology.
Analysis was conducted on a merged database representing 1187 trauma-exposed survivors of 12 different disasters studied systematically. DSM-IV-TR criteria for disaster-related PTSD were assessed with the Diagnostic Interview Schedule.
PTSD Group C (avoidance/numbing) and numbing specifically were less common and more associated than other symptom groups with criterion F (distress/impairment). Consistently in multivariable models, group C and numbing were independently associated with criterion F. Group D (hyperarousal) was less strongly associated with criterion F. Neither group B (intrusion) nor avoidance were associated with criterion F.
In this and other studies, group C and numbing specifically have been shown to be associated with criterion F, which is consistent with the demonstration that group C and the numbing component specifically are central to the psychopathology of PTSD. The addition of the distress/impairment requirement broadly across the psychiatric diagnoses in DSM-IV added little value to PTSD symptom criteria. Future revisions of diagnostic criteria may benefit by carefully considering these findings to possibly re-include a prominent numbing symptom section.
自 DSM-IV 中将临床显著的困扰/损伤标准纳入 PTSD 的定义以来，近四分之一的世纪过去了，很少有研究来检验该标准与症状群标准的关系，特别是与麻木亚组的关系。本研究旨在通过对一个大规模的灾难幸存者数据库进行分析，来检验这些关系，该数据库是通过对 12 种不同类型的灾难进行的 12 项不同事件进行的系统研究。
对一个合并数据库进行了分析，该数据库代表了 12 种不同灾难中 1187 名创伤暴露幸存者的研究结果。使用诊断访谈表评估了 DSM-IV-TR 与灾难相关 PTSD 的标准。
PTSD 组 C（回避/麻木）和麻木亚组比其他症状组与标准 F（困扰/损伤）的关联度更低，更常见。在多变量模型中，组 C 和麻木亚组与标准 F 独立相关。组 D（高度警觉）与标准 F 的关联度较低。组 B（侵入）和回避均与标准 F 无关。
在本研究和其他研究中，组 C 和麻木亚组与标准 F 有关，这与组 C 和麻木亚组与 PTSD 精神病学核心的关系一致。在 DSM-IV 中广泛添加困扰/损伤要求对 PTSD 症状标准几乎没有增加价值。未来的诊断标准修订可能会受益于仔细考虑这些发现，以可能重新包括一个突出的麻木症状部分。
