The stressor criterion for posttraumatic stress disorder: does it matter?

Area of Science:

• Psychiatry
• Psychology
• Epidemiology

Background:

• The definition of a stressor for posttraumatic stress disorder (PTSD) is under review for DSM-5.
• Understanding how different types of stressful events impact PTSD is crucial for diagnostic refinement.

Purpose of the Study:

• To investigate if PTSD symptoms, course, and consequences differ based on the type of precipitating stressful event.
• To inform the revision of the DSM-5 stressor criterion (Criterion A1).

Main Methods:

• Analysis of data from 3,013 women in the Nurses' Health Study II.
• Comparison of PTSD symptoms, duration, impairment, and sequelae based on whether the precipitating event met DSM-III, DSM-IV, or no DSM stressor criteria.

Main Results:

• Participants with PTSD from DSM-III qualifying events reported more symptoms on average than those from DSM-IV or non-DSM events.
• PTSD symptoms lasting 1 year or longer were more common in the DSM-III group.
• No systematic variation in PTSD sequelae was observed across different precipitating event types.

Conclusions:

• The current DSM stressor criterion may not be essential for characterizing PTSD.
• Expanding DSM-5 Criterion A1 may not significantly alter the understanding of PTSD phenomenology.
• Events not meeting DSM stressor criteria can result in PTSD as severe as those following DSM-III events, suggesting PTSD is a nonspecific stress response.