Full Review Need for Age-Appropriate Diagnostic Criteria for PTSD Andreas Maercker Department of Psychology, University of Zurich, Switzerland Abstract: Studies in patient or community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing disorder classification systems. This affects older people with traumatic experiences, who in their senescence report multiple mental disturbances and reduced quality of life. Thus, there is a need to develop age-appropriate diagnostic criteria for posttraumatic stress disorder (PTSD). To date, the new ICD-11 has done this only in a very rudimentary way. This article gives a brief historical overview and names the reasons for these diagnostic problems. Subsequently, it proposes six plus one (male-only) features to be dominant and life-stage specific in older adults: posttraumatic nightmares and reenactments, impaired sleep, painful memories of traumatically lost close persons, hypervigilance including elevated startle response, weakness or asthenia, somatoform pain or chronic primary pain, and in males only: reckless or self-destructive behavior. Finally, it outlines future steps to improve the adequate recognition of clinical presentations of trauma sequelae. Keywords: PTSD, trauma sequelae, old age, diagnostic features, age-appropriateness Introduction As part of the process of revising the definitions of trauma and stress-related disorders in the International Classifica- tion of Diseases, version 11 (ICD-11), the respective working group commenced working on diagnostic guidelines for “developmental presentations,” i.e., the clinical presenta- tion of posttraumatic stress disorder (PTSD) in different age groups including older age (Stein et al., 2020). This effort made it clear to those involved that there we have a very poor state of knowledge on the clinical presentation of PTSD in older age. The present article addresses this def- icit, notably by drawing on literature that is 20 to 30 years old because the topic was studied more frequently at that time than it has been since. In 1980, the diagnosis of PTSD was introduced into the U.S. classification system (Diagnostic and Statistical Man- ual of Mental Disorders: DSM-III, American Psychiatric Association, 1980) and 10 years later into the ICD-10 of the WHO (World Health Organization, 1991). The official classification of the diagnosis had a major impact on health, social, and other policies, such as those concerning the care for military veterans in many countries around the world. In clinical practice, the new diagnosis brought with it a great impetus for new psychological treatments, which improved the situation of those affected in many areas. In addition, the introduction of the diagnosis provided many impulses for various areas of basic research, of which only those on memory mechanisms and social-interpersonal processes should be mentioned here (e.g., Brewin, 2014; Maercker & Horn, 2013). Psychotraumatology in Older Age From the very beginning of the study of PTSD older people were often the focus of attention, partly because Holocaust survivors formed an important group of interest in psy- chotraumatological research. Groups of Holocaust sur- vivors were being studied in Israel, The Netherlands, and the United States as well as in several other countries (Bramsen & van der Ploeg, 1999; Kuch & Cox, 1992; Yehuda et al., 1995). Solomon (1995) presented a mono- graph examining in detail the psychological consequences of new-onset traumatic stress on older-aged Holocaust sur- vivors in Israel. In the United States, some comparative studies emerged in which World War II veterans were com- pared with those from the Korean and Vietnam Wars (e.g., Fontana & Rosenheck, 1994). In The Netherlands, veterans of the civil resistance movement were investigated (Op den Velde et al., 1994). This is also the context in which specific national treatment centers for survivors of the Shoah were established: Amcha (www.amcha.org) in Israel and Center 45 in The Netherlands (now “arq,” addressing all groups of traumatized persons: www.arq.org). Just three further examples should be mentioned from the large number of other early studies on older Ó 2021 Hogrefe GeroPsych (2021) https://doi.org/10.1024/1662-9647/a000260 https://econtent.hogrefe.com/doi/pdf/10.1024/1662-9647/a000260 - Andreas Maercker <maercker@psychologie.uzh.ch> - Monday, March 15, 2021 3:18:48 AM - IP Address:85.7.176.39