![]() It brings to the forefront the importance of carefully differentiating whether a patient’s stress reactions pertaining to their cancer experience are acute, yet interfering with functioning, indicative of AD, or more severe psychopathology such as PTSD.Īlthough ADs have been documented to be highly prevalent in cancer patients ranging up to 35% ( 7, 8), they have tended to be overlooked in studies specifically investigating the prevalence and characteristics of ca-PTSD. This heuristic framework also has potential utility for delineating psychological disturbances arising from cancer-related stress. Friedman and his colleagues ( 6) assert that there is heuristic value in grouping this set of disorders in a specific stress-related category as it enables clinicians to differentiate between normal (non-pathological) distress, from acute, diffuse clinically elevated stress reactions indicative of AD, to more severe and chronic psychopathology (including PTSD). In DSM-5, disorders which are precipitated by specific stressful and potentially traumatic events are included in a new diagnostic category, “Trauma and Stress-Related Disorders,” which includes both Adjustment Disorders (ADs) and PTSD ( 5). DSM-5: Trauma and Stress-Related Disorders The purpose of this paper is to evaluate the changes to the PTSD criteria in DSM 5, and the repercussions this has for screening, assessment, and treatment practices for cancer-related stress problems. With the Fifth Edition of DSM, there are some notable changes to screening for stress-related disorders and which have important implications for screening cancer patients and survivors. In fact, the prevalence rate for ca-PTSD has been documented to be considerably lower when utilizing the latter approach, ranging from 0 to 22% ( 3). The majority of research has been based on self-report questionnaires which has tended to inflate the rates of ca-PTSD (with prevalence rates as high as 55%) compared to studies that have used the gold-standard assessment method of structured, clinical diagnostic interviews ( 4). Since 1994, there has been a proliferation of studies investigating the prevalence and characteristics of cancer-related PTSD (ca-PTSD). Therefore, in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), being diagnosed with a life-threatening illness such as cancer was included for the first time as a potential traumatic event that could induce posttraumatic stress disorder (PTSD) ( 2). Indeed, cancer-related distress is common at pivotal periods in the prototypical trajectory of a cancer patients’ experience (including the diagnostic, treatment, recovery, and recurrence phases) and ranges on a continuum from normal, acute responses which may comprise initial fear post-diagnosis, to more severe, potentially chronic stress reactions that adversely impact functionality and general well-being. To this end, in 2009, the International Psycho-Oncology Society endorsed distress as the sixth vital sign in cancer care ( 1). It is well documented that being diagnosed and treated for cancer is understandably, a challenging experience associated with heightened distress.
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