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Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder?

Pivovarova, Ekaterina PhD*; Tanaka, Gen MD†‡; Tang, Michael DO, MPH†‡; Bursztajn, Harold J. MD§; First, Michael B. MD||

The Journal of Nervous and Mental Disease: January 2016 - Volume 204 - Issue 1 - p 3–8
doi: 10.1097/NMD.0000000000000416
Review Article

Criteria A2, experience of helplessness, fear, or horror at the time of the traumatic event, was removed from the posttraumatic stress disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We argue that there is empirical support for retention of A2, a criterion that has clinical value and may improve diagnostic accuracy. Specifically, we demonstrate that A2 has high negative predictive power, aids in the prediction of symptom severity, and can be indispensible to detecting the disorder in children. We examine how augmenting A2 with other peritramautic emotions could improve clinical and diagnostic utility. In our opinion, rather than being eliminated, A2 needs to be reconstructed and included as one criterion of PTSD.

*Division of Law and Psychiatry, Department of Psychiatry, University of Massachusetts Medical School, Worcester; †Harvard Medical School, Boston; ‡Veterans Association Boston Healthcare System, Brockton; §Program in Psychiatry and the Law, Beth Israel Deaconess Medical Center, Boston, MA; and ||Columbia University Department of Psychiatry, New York State Psychiatric Institute, New York, NY.

Send reprint requests to Ekaterina Pivovarova, PhD, 222 Maple Avenue, Shrewsbury, MA 01545. E-mail:

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