2984 – Disorders Specifically Associated with Stress

Abstract

Mental disorders specifically associated with stress are exceptional in requiring external events as causes of psychiatric symptoms in order to arrive at a diagnosis. The field is characterised by lively debates, including about the extent to which human suffering should be medicalised and the purportedly inflationary expansion of post-traumatic stress disorder (PTSD) diagnoses. The ICD-11 Working Group on this topic was asked to review scientific evidence and other information on use, clinical utility, and experience with relevant ICD-10 diagnoses in various health care settings; to review proposals for the American Psychiatric Association's DSM-5 and consider how these may be suited for global applications; and to assemble proposals for ICD-11 with a focus on improving clinical utility. The Working Group has recommended a separate grouping of ‘Disorders Specifically Associated with Stress’ for ICD-11, rather than combining them with anxiety disorders as in ICD-10 or DSM-IV. Disorders Specifically Associated with Stress have two key characteristics: 1) they are identifiable based on psychopathology that differs from other mental disorders; and 2) they arise in specific association with a stressful event or series of events. For each disorder in the grouping, the stressor is a necessary, though not sufficient, causal factor. The stressor may range from negative life events within the normal range of experience (in the case of adjustment disorder) to traumatic stressors of exceptional severity (in the case of PTSD and Complex PTSD).