Is Helplessness Still Helpful in Diagnosing Posttraumatic Stress Disorder

Ekaterina Pivovarova, University of Massachusetts Medical School
Gen Tanaka, Harvard Medical School
Michael Tang, Veterans Association Boston Healthcare System
Harold J. Bursztajn, Beth Israel Deaconess Medical Center
Michael B. First, Columbia University


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.