By Richard A. Bryant PhD
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Additional info for Acute Stress Disorder: What It Is and How to Treat It
It is worth noting that one of the initial messages that we received from the American Psychiatric Association was that changes should not be introduced into DSM-5 unless there were marked problems with the DSM-IV definition. This resulted in setting a reasonably high bar for justifying changes to the ASD diagnosis. The first issue that the group needed to decide on was the primary purpose of the diagnosis. Considering that virtually all active members of this group were from the United States (apart from me and Chris Brewin from the United Kingdom), it was quickly agreed on that having a diagnosis that identifies very distressed people in the initial month after trauma exposure was important to facilitate access to health care.
Three longitudinal studies defined subsyndromal ASD as not requiring the dissociative cluster. These findings suggest that focusing on general posttraumatic stress symptoms, rather than the more restrictive requirement of dissociation, allows more people who eventually develop PTSD to be identified in the acute phase. This approach is still flawed because the available studies indicate that even this strategy leads to the minority of people who develop PTSD to be identified in the acute phase. , 1999), or the overall level of acute symptoms (Bryant, Moulds, & Guthrie, 2000).
2 shows that four classes emerged: one class was the most distressed (Class 1), another was moderately distressed (Class 2), a third class was low on most symptoms except arousal (Class 3), and a fourth class was low on all symptoms (Class 4). The class that is most relevant to the ASD diagnosis was the class that was most distressed, which represented about 20% of the sample. Interestingly, this class had elevated levels of all ASD symptoms relative to the other classes. This provided a clue that this proportion may be an appropriate rate to identify people in the acute phase who are highly distressed.