Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Exploring DSM-5 criterion A in Acute Stress Disorder symptoms following natural disaster Osnat Lavenda a, ⁎ , Ephraim S. Grossman b , Menachem Ben-Ezra a , Yaakov Hoffman c a School of Social Work, Ariel University, Israel b The Herzog Academic College, Alon Shvut, Israel c Interdisciplinary Department of Social Sciences, Bar-Ilan University, Israel ARTICLE INFO Keywords: ASD DSM-5 Criterion A Psychological stress ABSTRACT The present study examines the DSM-5 Acute Stress Disorder (ASD) diagnostic criteria of exposure, in the context of a natural disaster. The study is based on the reports of 1001 Filipinos following the aftermath of super typhoon Haiyan in 2013. Participants reported exposure to injury, psychological distress and ASD symptoms. Findings indicated the association of criterion A with the prevalence of meeting all other ASD diagnostic criteria and high psychological distress. The diagnostic properties of Criterion A are discussed. 1. Introduction On November 8, 2013, a category 5 super Typhoon Haiyan struck the Philippines, killing over 6000 people and affecting 11 million Filipinos. Exposure to such a large scale event meets the Diagnostic and Statistical Manual (DSM-5) Criterion A. Criterion A refers to one's ex- posure to life threatening events in which an individual may die, be in a state where one's life is threatened actual, threatened serious injury, or threatened sexual violence (American Psychiatric Association, 2013). Criterion A is a necessary condition for diagnosing stress-related psy- chiatric conditions, such as Acute Stress Disorder (ASD). Since the publication of the fifth edition of the DSM there is a growing interest in the predictive power of diagnostic criteria of Post- Traumatic Stress Disorder (PTSD) and ASD (Bryant et al., 2015; Calhoun et al., 2012; Kilpatrick et al., 2013. The role of Criterion A, is in particular controversial. It appears that some would consider it re- dundant (Maier, 2007), while others argue it is important for differ- entiating extreme events from altered reality (Hoffman et al., 2011). Similar to PTSD, ASD diagnosis is given in the immediate aftermath of a life threatening event or following injuries, while the difference between these diagnoses derives from the period of time in which the symptoms last (Bryant et al., 2011; Zoellner et al., 2003). Studies have repeatedly indicated ASD to be a precursor of PTSD (Bryant et al., 2015; Zoellner et al., 2003). Due to modifications made from the fourth to the fifth edition (American Psychiatric Association, 2013), much attention was drawn to the addition of negative alterations as a fourth class of criterion and to the way ASD is now scored. Contemporary research focuses much less on how satisfying the DSM-5 criterion A is related to the remaining ASD symptoms, especially in the context a natural disaster (Bryant et al., 2015; Mills et al., 2007), such as the present typhoon, where even those who were not exposed on a DSM-5 level were likely exposed to some extent by virtue living in the same region. The present study aims at narrowing this gap in knowledge by ex- amining the association of meeting DSM-5 Criterion A with meeting the other DSM-5 diagnostic criteria of ASD, as well as reporting high psy- chological distress, among survivors of super Typhoon Haiyan, in the Philippines. The present study is of exploratory nature as it is the first to examine these associations. If indeed the DSM-5 criteria are valid, it is expected that those participants exposed to criterion A event should be significantly more likely to meet the other DSM-5 criteria for ASD than participants who did not report being exposed to criterion A event. 2. Methods Following the approval of the ethics committee of the School of Social Work at Ariel University, an online panel survey was conducted in the Philippines within 3 weeks of the event (week of the 27.11.13), using “Asia Opinions”, a survey company specializes in East Asia. The panel was created using random stratified sampling methods, using weights for key demographic elements that were compared with the Philippines Census information, to create a reliable approximation of a representative sample, based on the age and sex. The sample consisted of 1001 participants (Mean Age = 30.36 [SD = 10.37]. Gender was evenly represented in the sample (50.01% women)), and about third of the sample (36.6%) reported being married. http://dx.doi.org/10.1016/j.psychres.2017.07.016 Received 29 December 2016; Received in revised form 15 April 2017; Accepted 9 July 2017 ⁎ Correspondence to: Ariel University, Ariel, Israel. E-mail address: osnat.lavenda@gmail.com (O. Lavenda). Psychiatry Research 256 (2017) 458–460 Available online 10 July 2017 0165-1781/ © 2017 Elsevier B.V. All rights reserved. MARK