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FIGHT to remember PTSD
Certain clinical features of posttraumatic stress disorder (PTSD) appear in other psychiatric diagnoses and therefore can confound accurate diagnosis and treatment. PTSD is frequently comorbid with other classes of psychiatric disorders, including mood, personality, substance use, and psychotic disorders, which can further complicate diagnostic clarity. Comorbidity in PTSD is important to recognize because it has been associated with worse treatment outcomes.1
In DSM-5, the updated criteria for PTSD included Criterion D: “Negative alterations in cognitions and mood associated with the traumatic event(s) ….”2 In addition to inability to remember an important aspect of the trau
We created the mnemonic FIGHT to help remember the updated DSM-5 criteria for PTSD when considering the differential diagnosis.
Flight. Avoidant symptoms, including efforts to avoid distressing memories, thoughts, or feelings about the traumatic event, as well as avoidance of external reminders.
Intrusive symptoms, such as distressing dreams, intrusive memories, and physiological distress when exposed to cues.
Gloomy cognitions. Negative cognitions and mood associated with the traumatic event.
Hypervigilance. Alterations in arousal, such as irritability, angry outbursts, reckless behavior, and exaggerated startle response.
Trauma. Exposure to actual or threatened death, serious injury, or sexual violence.
A diagnosis of PTSD requires ≥1 month of symptoms that cause significant distress or impairment and are not attributable to the physiological effects of a substance or medical condition. Specifiers in DSM-5 include with depersonalization or derealization, as well as delayed expression.2
Vigilance in the assessment and treatment of PTSD will aid the clinician and patient in producing better care outcomes.
1. Angstman KB, Marcelin A, Gonzalez CA, et al. The impact of posttraumatic stress disorder on the 6-month outcomes in collaborative care management for depression. J Prim Care Community Health. 2016;7(3):159-164.
2. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
Certain clinical features of posttraumatic stress disorder (PTSD) appear in other psychiatric diagnoses and therefore can confound accurate diagnosis and treatment. PTSD is frequently comorbid with other classes of psychiatric disorders, including mood, personality, substance use, and psychotic disorders, which can further complicate diagnostic clarity. Comorbidity in PTSD is important to recognize because it has been associated with worse treatment outcomes.1
In DSM-5, the updated criteria for PTSD included Criterion D: “Negative alterations in cognitions and mood associated with the traumatic event(s) ….”2 In addition to inability to remember an important aspect of the trau
We created the mnemonic FIGHT to help remember the updated DSM-5 criteria for PTSD when considering the differential diagnosis.
Flight. Avoidant symptoms, including efforts to avoid distressing memories, thoughts, or feelings about the traumatic event, as well as avoidance of external reminders.
Intrusive symptoms, such as distressing dreams, intrusive memories, and physiological distress when exposed to cues.
Gloomy cognitions. Negative cognitions and mood associated with the traumatic event.
Hypervigilance. Alterations in arousal, such as irritability, angry outbursts, reckless behavior, and exaggerated startle response.
Trauma. Exposure to actual or threatened death, serious injury, or sexual violence.
A diagnosis of PTSD requires ≥1 month of symptoms that cause significant distress or impairment and are not attributable to the physiological effects of a substance or medical condition. Specifiers in DSM-5 include with depersonalization or derealization, as well as delayed expression.2
Vigilance in the assessment and treatment of PTSD will aid the clinician and patient in producing better care outcomes.
Certain clinical features of posttraumatic stress disorder (PTSD) appear in other psychiatric diagnoses and therefore can confound accurate diagnosis and treatment. PTSD is frequently comorbid with other classes of psychiatric disorders, including mood, personality, substance use, and psychotic disorders, which can further complicate diagnostic clarity. Comorbidity in PTSD is important to recognize because it has been associated with worse treatment outcomes.1
In DSM-5, the updated criteria for PTSD included Criterion D: “Negative alterations in cognitions and mood associated with the traumatic event(s) ….”2 In addition to inability to remember an important aspect of the trau
We created the mnemonic FIGHT to help remember the updated DSM-5 criteria for PTSD when considering the differential diagnosis.
Flight. Avoidant symptoms, including efforts to avoid distressing memories, thoughts, or feelings about the traumatic event, as well as avoidance of external reminders.
Intrusive symptoms, such as distressing dreams, intrusive memories, and physiological distress when exposed to cues.
Gloomy cognitions. Negative cognitions and mood associated with the traumatic event.
Hypervigilance. Alterations in arousal, such as irritability, angry outbursts, reckless behavior, and exaggerated startle response.
Trauma. Exposure to actual or threatened death, serious injury, or sexual violence.
A diagnosis of PTSD requires ≥1 month of symptoms that cause significant distress or impairment and are not attributable to the physiological effects of a substance or medical condition. Specifiers in DSM-5 include with depersonalization or derealization, as well as delayed expression.2
Vigilance in the assessment and treatment of PTSD will aid the clinician and patient in producing better care outcomes.
1. Angstman KB, Marcelin A, Gonzalez CA, et al. The impact of posttraumatic stress disorder on the 6-month outcomes in collaborative care management for depression. J Prim Care Community Health. 2016;7(3):159-164.
2. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
1. Angstman KB, Marcelin A, Gonzalez CA, et al. The impact of posttraumatic stress disorder on the 6-month outcomes in collaborative care management for depression. J Prim Care Community Health. 2016;7(3):159-164.
2. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
How to use patient-centered language in documentation
Discuss this article at www.facebook.com/CurrentPsychiatry
As psychiatric care transitions to using electronic medical records, providers should be aware that patients—and their legal representation— have increasing access to their medical records. Use of patient-centered, nonjudgmental language will better preserve the physician/patient alliance.
Consider the type of language you would find acceptable in documents describing the care provided to you or a loved one. Whenever possible, describe behavior by using objective and phenomenological terms. Nothing is sacrificed by replacing words that carry a negative connotation with less charged words. However, it is acceptable— and can add to the evaluation—to quote the patient’s own words.
The Table below lists alternative terms and phrases for use in psychiatric documentation.
Table
Nonjudgmental language for psychiatric documentation
| Language with negative connotation | Patient-centered language |
|---|---|
| Promiscuity | Impulsive sexual behavior |
| Self-mutilation | Nonsuicidal self-injury |
| Manipulative, ‘gamey’ | The patient sought to meet their need of… (or describe specific behaviors) |
| Refused medication | Declined or chose not to accept medication |
| Nasty, rude, mean | The patient used offensive language. The patient behaved in an aggressive manner by… |
| Trigger | Prompt |
| Demanding | Made repeated requests |
| Noncompliant | Did not adhere to the treatment plan |
| Frantic, desperate | Urgent, acute, demonstrated intense feelings of… |
| Disturbed, dysfunctional | Dysregulated, difficult to manage |
| Needy | Sought reassurance |
| Failed medication trial | Treatment with this medication was not associated with improvement |
| Shopping spree | Impulsive spending behavior |
| The patient complains of… | The patient reported… |
| Drug binge | Heavy substance use over a short period |
Disclosure
Dr. Nelson receives grant research/support from the Minnesota Medical Foundation.
Discuss this article at www.facebook.com/CurrentPsychiatry
As psychiatric care transitions to using electronic medical records, providers should be aware that patients—and their legal representation— have increasing access to their medical records. Use of patient-centered, nonjudgmental language will better preserve the physician/patient alliance.
Consider the type of language you would find acceptable in documents describing the care provided to you or a loved one. Whenever possible, describe behavior by using objective and phenomenological terms. Nothing is sacrificed by replacing words that carry a negative connotation with less charged words. However, it is acceptable— and can add to the evaluation—to quote the patient’s own words.
The Table below lists alternative terms and phrases for use in psychiatric documentation.
Table
Nonjudgmental language for psychiatric documentation
| Language with negative connotation | Patient-centered language |
|---|---|
| Promiscuity | Impulsive sexual behavior |
| Self-mutilation | Nonsuicidal self-injury |
| Manipulative, ‘gamey’ | The patient sought to meet their need of… (or describe specific behaviors) |
| Refused medication | Declined or chose not to accept medication |
| Nasty, rude, mean | The patient used offensive language. The patient behaved in an aggressive manner by… |
| Trigger | Prompt |
| Demanding | Made repeated requests |
| Noncompliant | Did not adhere to the treatment plan |
| Frantic, desperate | Urgent, acute, demonstrated intense feelings of… |
| Disturbed, dysfunctional | Dysregulated, difficult to manage |
| Needy | Sought reassurance |
| Failed medication trial | Treatment with this medication was not associated with improvement |
| Shopping spree | Impulsive spending behavior |
| The patient complains of… | The patient reported… |
| Drug binge | Heavy substance use over a short period |
Disclosure
Dr. Nelson receives grant research/support from the Minnesota Medical Foundation.
Discuss this article at www.facebook.com/CurrentPsychiatry
As psychiatric care transitions to using electronic medical records, providers should be aware that patients—and their legal representation— have increasing access to their medical records. Use of patient-centered, nonjudgmental language will better preserve the physician/patient alliance.
Consider the type of language you would find acceptable in documents describing the care provided to you or a loved one. Whenever possible, describe behavior by using objective and phenomenological terms. Nothing is sacrificed by replacing words that carry a negative connotation with less charged words. However, it is acceptable— and can add to the evaluation—to quote the patient’s own words.
The Table below lists alternative terms and phrases for use in psychiatric documentation.
Table
Nonjudgmental language for psychiatric documentation
| Language with negative connotation | Patient-centered language |
|---|---|
| Promiscuity | Impulsive sexual behavior |
| Self-mutilation | Nonsuicidal self-injury |
| Manipulative, ‘gamey’ | The patient sought to meet their need of… (or describe specific behaviors) |
| Refused medication | Declined or chose not to accept medication |
| Nasty, rude, mean | The patient used offensive language. The patient behaved in an aggressive manner by… |
| Trigger | Prompt |
| Demanding | Made repeated requests |
| Noncompliant | Did not adhere to the treatment plan |
| Frantic, desperate | Urgent, acute, demonstrated intense feelings of… |
| Disturbed, dysfunctional | Dysregulated, difficult to manage |
| Needy | Sought reassurance |
| Failed medication trial | Treatment with this medication was not associated with improvement |
| Shopping spree | Impulsive spending behavior |
| The patient complains of… | The patient reported… |
| Drug binge | Heavy substance use over a short period |
Disclosure
Dr. Nelson receives grant research/support from the Minnesota Medical Foundation.