In PTSD, the DSM-5 requires four symptom clusters. Which of the following represents the cluster added in DSM-5 that was NOT present in the DSM-IV PTSD criteria?
- A Intrusion symptoms (flashbacks, nightmares)
- B Avoidance of trauma-related stimuli
- C Negative alterations in cognitions and mood (e.g., persistent negative beliefs, emotional numbing, anhedonia) ✓
- D Hyperarousal (hypervigilance, exaggerated startle response)
Explanation
DSM-IV PTSD had three clusters: re-experiencing, avoidance/numbing, and hyperarousal. DSM-5 expanded this to four clusters by separating 'negative alterations in cognitions and mood' as a distinct cluster (Cluster D) from the avoidance cluster. Cluster D includes: persistent negative beliefs about self/world, distorted blame, persistent negative emotions, anhedonia, feelings of detachment/estrangement, and inability to experience positive emotions. This change acknowledged that emotional numbing and cognitive distortions are qualitatively distinct from simple avoidance behaviour.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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