0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
PTSD, Acute Stress Disorder, and DSM-V
PAULA J. CLAYTON, M.D.
Am J Psychiatry 2004;161:584-584. doi:10.1176/appi.ajp.161.3.584

To the Editor: For a psychiatrist unfamiliar with the specific criteria for posttraumatic stress disorder (PTSD) and acute stress disorder, there were two recent articles by Ruth A. Lanius, M.D., Ph.D., et al. (1) and by Chris R. Brewin, Ph.D., et al. (2) that were extremely enlightening. The first group reported that a husband and wife who experienced the same trauma had different emotional and physiological responses to it. They were seen and assessed 4 weeks after the trauma. Both met criteria for acute stress disorder and PTSD. The wife had a high score on the Peritraumatic Dissociative Experiences Scale, but both had low scores on the Dissociative Experiences Scale. They also had different responses to script-driven traumatic imagery, as measured by T4 functional magnetic resonance imaging, heart rate, and self-reported measures.

The second article compared the diagnostic overlap between acute stress disorder and PTSD in victims of violent crimes. Ignoring the criterion for acute stress disorder that requires it to be of only 1 month’s duration, they found that 19% of the victims met the criteria for acute stress disorder and 21% for PTSD, which prominently overlapped. Both predicted an outcome of PTSD at 6 months. Could it be that in the first article the husband had typical PTSD and the wife had typical acute stress disorder (also with PTSD)? The husband did well with exposure-based treatment, but the wife did not and still had PTSD after 6 months. It could be, as Brewin et al. (2) stated, that peritraumatic dissociation is a psychological process that impedes the processing of information during the trauma. Perhaps it requires a different treatment. I do not know what the preferred treatment is for acute stress disorder.

I believe that these two articles highlight a direction for future research in this area by emphasizing the likeness and differences of these two disorders, their different pathophysiologies, and their different responses to treatment. I am not sure how the treatments relate to the treatment currently being tested for another stress-related condition, complicated bereavement.

Certainly, with such similarities, it would be imperative for the committee working on DSM-V that deals with this category to consider the overlap of these two disorders and for those who do research in this area to consider them when explaining research findings. Where, for instance, do the animal models for response to stress best fit? Are these the same reaction with different gender responses, as the first article might imply? Since both conditions usually occur immediately after a stressor, maybe the word "acute" and the 1-month duration should be dropped from the criteria for acute stress disorder.

I thank both groups of authors for their interesting articles. The first article was provocative, and the second was informative because it further quantified the criteria for the two conditions.

Lanius RA, Hopper JW, Menon RS: Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: a functional MRI case study (case conf). Am J Psychiatry  2003; 160:667–669
[PubMed]
[CrossRef]
 
Brewin CR, Andrews B, Rose S: Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime. Am J Psychiatry  2003; 160:783–785
[PubMed]
[CrossRef]
 
+

References

Lanius RA, Hopper JW, Menon RS: Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: a functional MRI case study (case conf). Am J Psychiatry  2003; 160:667–669
[PubMed]
[CrossRef]
 
Brewin CR, Andrews B, Rose S: Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime. Am J Psychiatry  2003; 160:783–785
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 12.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles