A 40-year-old man was trapped in a building collapse. For eight months he functioned normally. He then developed intrusive memories, nightmares, avoidance of rubble sites, negative beliefs about himself, and exaggerated startle lasting over three months. Which DSM-5 specifier applies to his PTSD?

• A Chronic, severe
• B With dissociative symptoms
• C With delayed expression ✓
• D With psychotic features

Explanation

The delayed expression specifier is applied when the full diagnostic threshold of PTSD is not met until at least six months after the traumatic event, although some symptoms may begin earlier. This patient was asymptomatic for eight months before meeting full criteria. The dissociative specifier requires prominent depersonalisation or derealisation, which he does not have, killing option B. There is no chronicity or psychotic specifier in DSM-5 PTSD.

Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 5th ed.

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