This proposed new cluster also encompasses the nonfear, dysphoric mood states associated with PTSD such as guilt, shame, anger, and disgust. The avoidance (C1 and C2) criteria have been retained unchanged, while the erstwhile numbing criteria have been somewhat reconceptualized and placed in a new cluster that we have named “negative cognitions and mood.” We have divided the C Criterion (avoidance/numbing) into two distinct clusters since the vast majority of confirmatory factor-analysis studies indicate that avoidance and numbing are quite distinct from one another. The A2 Criterion (responding to an A1 event with fear, helplessness, or horror) has been eliminated because it has failed to predict PTSD onset, substantially restrict the number of cases meeting the A Criterion, or exhibit any clinical utility. As a result, our proposed DSM-5 A Criterion retains the “learned about” category but has attempted to narrow the list of qualifying events to reduce ambiguity and forensic misrepresentations. However, there is good evidence that PTSD does occur among people who have learned about the homicide, gruesome death, grotesque details of rape, genocide, or violent abuse of a loved one. Some have recommended elimination of this part of the criterion because, they argue, it opens the door too wide for qualifying traumatic events. The most controversial aspect of the DSM-IV A1 Criterion is “learning about” the traumatic exposure of a close friend or loved one. It has also addressed cross-cultural issues related to PTSD.įinally, the sub-work group addressed forensic issues, particularly the current A1 Criterion (identifying events that are considered “traumatic”), which some consider to be too broad, ambiguous, and easily manipulated in courtroom proceedings and disability claims. The sub-work group collaborated with the Childhood and Adolescent Disorders Work Group to produce developmentally sensitive diagnostic criteria. Guest experts were often invited to participate in those discussions and to submit papers, data, or new data analyses to support their positions. The sub-work group undertook a number of comprehensive reviews of the empirical literature and discussed and debated them during twice-monthly two-hour teleconferences and several face-to-face meetings. In addition, approximately 50 PTSD experts were surveyed regarding their opinions on key issues such as Criterion A, the latent structure of PTSD, acute stress disorder (ASD), disorders of extreme stress not otherwise specified (DESNOS)/complex PTSD, and developmental, cultural, and forensic issues. We encouraged two professional societies, the International Society for Traumatic Stress Studies and the Anxiety Disorders Association of America, to provide feedback from their members through symposia, panel discussions, and workshops convened at their annual meetings. To develop the preliminary proposed posttraumatic stress disorder (PTSD) criteria that were posted online for public comment until April 20, the PTSD, Trauma, and Dissociative Disorders Sub-Work Group of the Anxiety Disorders Work Group for DSM-5 sought input from a wide variety of advisors and experts.