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The changed face of PTSD diagnosis.

This issue of the Journal contains a special section on the new diagnostic criteria for posttraumatic stress disorder (PTSD) and related disorders in the recently published Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013). In 2009, we published an editorial, “The Changing Face of PTSD Diagnosis” (Schnurr, 2009), describing the initial activities by the Journal of Traumatic Stress and the International Society for Traumatic Stress Studies to report on the revision of the DSM-IV (APA, 1994). Now, in 2013, the change—the changes, actually—have occurred. The most significant is that PTSD is no longer classified as an anxiety disorder. Instead, PTSD is included in a category of disorders related to traumatic and stressful events. This change reflects recognition of the fact not all traumatizing events are fear-based and that we needed to expand the categorization of serious reactions other than PTSD that can occur following stressor exposure. The special section begins with an article by Kilpatrick and colleagues (2013) on the differences in diagnostic outcome between the DSM-IV and the DSM-V. Several of the findings are particularly important. In general, the prevalence of PTSD appears to be somewhat lower according to the DSM-5 than according to the DSM-IV. Exploration of the reasons behind the lower prevalence suggests that the reduction is appropriate. The primary reason individuals who met diagnostic criteria according to the DSM-IV but not according to the DSM-5 is the elimination from Criterion A of sudden death of a loved one due to natural causes. Counting natural death as a Criterion A event had been a controversial issue since its introduction in DSM-IV.