A 32-year-old combat veteran presents 8 months after returning from active duty. He reports intrusive flashbacks triggered by car backfires, emotional numbing, sleep disturbance, hypervigilance, inability to recall details of the traumatic event, and persistent negative beliefs about himself. He avoids news, TV, and crowds. His symptoms have been present for 6 months. Which DSM-5 cluster of PTSD symptoms does 'emotional numbing and negative cognitions' fall under?
- A Cluster B: Intrusion symptoms
- B Cluster C: Avoidance
- C Cluster D: Negative alterations in cognitions and mood ✓
- D Cluster E: Hyperarousal and reactivity
Explanation
DSM-5 reorganised PTSD into 4 clusters (previously 3 in DSM-IV): Cluster B: Intrusions (flashbacks, nightmares, psychological distress to cues); Cluster C: Avoidance (internal/external reminders); Cluster D: Negative alterations in cognitions and mood (inability to recall trauma details, persistent negative beliefs, distorted blame of self/others, anhedonia, emotional numbing, estrangement, restricted affect); Cluster E: Alterations in arousal and reactivity (hypervigilance, exaggerated startle, sleep disturbance). Cluster D was separated from avoidance in DSM-5, and this distinction is clinically important — it targets the 'frozen/numbing' dimension often missed in treatment planning.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.