Pilot study to validate criteria for proposed new DSM IV category: Disorders of extreme stress not otherwise specified (DESNOS)

No one diagnostic category exists that clearly delineates the essence of chronic victimization. Literature review and pilot studies have shown that most victims of abuse do not manifest the full syndrome of Post-Traumatic Stress Disorder (PTSD). A new diagnostic category, Disorders of Extreme Stress Not Otherwise Specified (DESNOS), has been proposed for consideration in DSM-IV. A pilot study to validate criteria for DESNOS was conducted by systematically investigating the charts of thirty-five child and adolescent out-patients for the presence of PTSD symptomatology as well as for symptoms of DESNOS. It was not possible to determine the number of criteria necessary to state that DESNOS is present in any given patient. It was hypothesized that a significant percentage of victims of abuse would manifest the criteria for DESNOS and that a significantly greater percentage of victims would manifest the criteria for DESNOS than would manifest the criteria for PTSD. The percentage of each item receiving an affirmative response was examined to determine trends regarding which DESNOS criteria appear most frequently in victims of sexual abuse. Hypothesized differences between DESNOS and PTSD were not found. However, a significantly high percentage of DESNOS Symptomatology were present in a large number of subjects. Ninety-two percent of the subjects met at least one criterion in the area of Alterations of Affect. Eighty-three percent of the subjects met at least one criterion in the area of Alterations in Attention. One hundred percent of the subjects met at least one criterion in the area of Alterations in Self-Perception. Eighty-three percent of the subjects met at least one criterion in the area of Alterations in the Perception of the Perpetrator. Seventy-two percent of the subjects met at least one criterion in the area of Alterations in Relations with Others. Thirty-two percent of the subjects met at least criterion in the area of Alterations in Systems of Meaning. In the PTSD category, fifty-four percent of the subjects met criteria in the area of Avoidance and Numbing, forty-six percent met criteria in the area of Re-experiencing of Trauma, and forty-three percent met criteria in the area of Increased Arousal. (Abstract shortened with permission of author.