University of Massachusetts Medical School Faculty Publications


Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder

UMMS Affiliation

Division of Law and Psychiatry, Department of Psychiatry; Systems and Psychosocial Advances Research Center

Publication Date


Document Type



Diagnosis | Mental and Social Health | Mental Disorders | Pediatrics | Psychiatry | Psychiatry and Psychology | Trauma


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.


PTSD, DSM-5, diagnostic utility, trauma, diagnostic accuracy

DOI of Published Version



J Nerv Ment Dis. 2016 Jan;204(1):3-8. doi: 10.1097/NMD.0000000000000416. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The Journal of nervous and mental disease

PubMed ID