The Utility of the DSM Posttraumatic Stress Disorder Criterion A2 among Chronically Traumatized Adolescents
Ilana B. Barry, Psy.D.
Chair: Eva Feindler, Ph.D.
July 30, 2014
Recent trauma research indicates that criterion A2 of the DSM-IV Posttraumatic Stress Disorder (PTSD) diagnosis may not serve its intended purpose to increase the specificity and accuracy of the PTSD diagnosis. Criterion A2 is defined as “the person’s response involved intense fear, helplessness, or horror” upon exposure to a traumatic event (4th ed., rev.; DSM–IV–R; American Psychiatric Association, 2000, p.467). The development of the concept of complex trauma has complicated this diagnostic issue further due to the different subjective experience of trauma among individuals who experience early and pervasive trauma, as compared to those who experience a single episode of trauma. The recent publication of DSM-5 and the removal of criterion A2 from the PTSD diagnosis further supports the assertion that criterion A2 has little diagnostic utility. Although many studies have explored the utility of criterion A2 in diagnosing PTSD in traumatized adult populations, there is far less research exploring the utility of criterion A2 in diagnosing PTSD in chronically traumatized populations, particularly with chronically traumatized youth. Using archival data from a pilot study examining the effectiveness of the Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) psychosocial group intervention in reducing post-trauma symptomatology in chronically traumatized adolescents, the following study examined the relationship between the endorsement of criteria A1 and A2 of the DSM-IV PTSD diagnosis. Participants consisted of 241 chronically traumatized adolescents (male: n=56; female: n=184), between the ages of 12 and 18. Results indicated that 89.6% of the total sample of adolescents endorsed criterion A2 (n=216) in addition to criterion A1, whereas only 3.1% (n=7) of the sample endorsed criterion A1 alone. These results suggest that the inclusion of criterion A2 in the DSM-IV PTSD diagnosis does not increase the validity of the diagnosis for chronically traumatized adolescents.