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Correspondence |

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Impact of Events Scale-RevisedImpact of Events Scale-Revised FREE TO VIEW

Sundar Gnanavel, MD; Ruby Stella Robert, MBBS
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From the Department of Psychiatry (Dr Gnanavel), All India Institute of Medical Sciences; and Department of Physiology and Cardiopulmonary Rehabilitation (Dr Robert), Vallabhbhai Patel Chest Institute.

Correspondence to: Sundar Gnanavel, MD, Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India; e-mail: sundar221103@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1974. doi:10.1378/chest.13-1691
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To the Editor:

We read with great interest the article by Bienvenu et al1 in a recent issue of CHEST (July 2013) and would like to compliment them on the development and validation of the Impact of Events Scale-Revised (IES-R) for patients with posttraumatic stress disorder (PTSD) after acute lung injury. Psychiatric nosology and diagnostic classification systems are always dynamic and in a state of flux. The authors developed the screening questionnaire and validated it against the Clinician-Administered PTSD Scale (CAPS), which is based on Diagnostic and Statistical Manual of Mental Disorders (DSM), fourth edition, diagnostic criteria. However, the recently introduced fifth edition (DSM-5) has revised the conceptualization as well as the diagnostic criteria for PTSD, which has definite implications for the screening instrument proposed in the study.

PTSD was moved from the class of anxiety disorders into a new class of trauma and stressor-related disorders. The cluster of symptoms in the fourth edition has been expanded in DSM-5 to include intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. DSM-5 now requires at least one avoidance symptom for a PTSD diagnosis. Three new symptoms were added: two in criteria D (negative alterations in cognitions and mood) to include persistent, distorted blame of self or others and persistent negative emotional state and one in criteria E (alterations in arousal and reactivity) to include reckless or destructive behavior.2 Criterion A2 (requiring fear, helplessness, or horror happening right after the trauma) was removed in DSM-5 because research suggested that this criterion does not improve diagnostic accuracy.3 A clinical subtype with dissociative symptoms was added for those who meet the criteria for PTSD and experience additional depersonalization and derealization symptoms.

CAPS, the psychometric instrument against which the IES-R was validated, is currently being revised to ensure its compatibility with DSM-5 diagnostic criteria for PTSD. These changes lead to the inference that the IES-R would require substantial revision and validation against the revised CAPS to ensure its clinical utility in the future.

References

Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised. Chest. 2013;144(1):24-31. [CrossRef] [PubMed]
 
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington, DC: American Psychiatric Association; 2013.
 
Friedman MJ, Resick PA, Bryant RA, Brewin CR. Considering PTSD for DSM-5. Depress Anxiety. 2011;28(9):750-769. [CrossRef] [PubMed]
 

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References

Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised. Chest. 2013;144(1):24-31. [CrossRef] [PubMed]
 
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington, DC: American Psychiatric Association; 2013.
 
Friedman MJ, Resick PA, Bryant RA, Brewin CR. Considering PTSD for DSM-5. Depress Anxiety. 2011;28(9):750-769. [CrossRef] [PubMed]
 
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