**3. Results**

#### **3.1. ASD cases and incidence of PTSD**

**Table 2** presents the percentage of individuals who met criteria for ASD and PTSD diagnoses. At the initial assessment (T0), 39 victims of violent crimes (52%) met criteria for full ASD, and 15 victims (20%) for partial ASD. These 15 individuals did not meet criteria for dissociation (i.e., fewer than the three symptoms required). At the 2-month post-trauma assessment (T1), 21 victims (40%) met full criteria for PTSD and nine victims (17%) met criteria for partial PTSD. Partial diagnoses were due to individuals not meeting criteria for avoidance (i.e., *n* = 9, fewer than the three symptoms required).


**Table 2.** Percentages of individuals with full, partial, and no ASD diagnoses who met criteria for full, partial, and no PTSD.

Among individuals who completed both assessments, 15 (60%) of those who had received a diagnosis of full ASD met full criteria for PTSD at the 2-month follow-up. Of those with a partial ASD diagnosis, six victims (55%) met full criteria for PTSD and two victims (18%) met partial criteria for PTSD. The 55% within the partial ASD group that met full criteria for PTSD consisted of individuals who did not meet criteria for dissociation.

#### **3.2. Predictive power of ASD diagnosis and clusters on PTSD**

**Table 3** presents positive and negative predictive power of ASD clusters on PTSD. Positive predictive power was calculated by dividing the number of individuals who reported each ASD cluster and who later developed PTSD (i.e., full and partial diagnoses combined) by the total number of individuals who reported each ASD cluster. Negative predictive power was calculated by dividing the number of individuals who did not report each ASD cluster and who later did not develop PTSD (full and partial combined) by the total number of those who did not report the cluster.


a The probability of the presence of PTSD when the criteria for the cluster were met.

b The probability of the absence of PTSD when the criteria for the cluster were not met.

c Full and partial diagnoses combined.

classified as having full ASD. Partial ASD was diagnosed when individuals met all criteria except for criteria B, for which only one out of three dissociative symptoms was required [18]. The ASDI has shown good internal consistency (*α* = 0.90), temporal stability (*r* = 0.90), sensi-

The structured clinical interview for DSM-IV axis I disorders (SCID-I) [27] was used at T1 to assess the presence or absence of PTSD (i.e., full, partial, or no diagnosis) and other axis I diagnoses. Partial PTSD was diagnosed when individuals met all criteria for each cluster except one (i.e., B, C, or D) [18]. This semi-structured interview showed good convergent validity according to clinicians' judgment (*k* = 0.69), as well as an inter-rater reliability ranging from

**Table 2** presents the percentage of individuals who met criteria for ASD and PTSD diagnoses. At the initial assessment (T0), 39 victims of violent crimes (52%) met criteria for full ASD, and 15 victims (20%) for partial ASD. These 15 individuals did not meet criteria for dissociation (i.e., fewer than the three symptoms required). At the 2-month post-trauma assessment (T1), 21 victims (40%) met full criteria for PTSD and nine victims (17%) met criteria for partial PTSD. Partial diagnoses were due to individuals not meeting criteria for avoidance (i.e., *n* = 9, fewer

**Criteria** *N* **% # contacted Criteria** *N* **%** Full 39 52.0 25 Full 15 60.0

Partial 15 20.0 11 Full 6 54.5

None 21 26.9 16 Full 0 0.0

**Table 2.** Percentages of individuals with full, partial, and no ASD diagnoses who met criteria for full, partial, and no

Partial 6 24.0 None 4 16.0

Partial 2 18.2 None 3 27.3

Partial 1 6.3 None 15 93.8

bility (91%), and specificity (93%) based on clinicians' judgment [26].

136 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

0.77 to 0.92 [28].

**3. Results**

**3.1. ASD cases and incidence of PTSD**

than the three symptoms required).

Total 75 52

PTSD.

**ASD (T0) PTSD (T1)**

**Table 3.** Positive and negative predictive power for PTSD of each ASD cluster.

Results show that both negative and positive predictive power were moderate for all clusters (i.e., 0.50–0.67) and negative predictive power was high for ASD diagnosis (i.e., 0.94) according to Cohen (0.2 for low, 0.5 for moderate, and 0.8 for high [23]). A logistic regression analysis with PTSD diagnosis as the dependant variable (i.e., full and partial combined compared to no diagnosis) and each individual cluster (i.e., B, C, D, and E) and overall ASD diagnosis (i.e., full and partial) as independent variables were performed to determine the percentage of correct PTSD classification. Dissociation provided the lowest score compared to clusters C, D, E, and ASD diagnosis. However, no significant differences emerged based on Cochran's *Q*-test.

#### **3.3. Predictive power of ASD symptoms on PTSD**

**Table 4** presents the percentage of individuals who reported each ASD symptom as a function of their PTSD diagnostic status at 2 months post trauma. Full PTSD and partial PTSD diagnoses were grouped together for the purpose of these analyses. Chi-squared analyses of individuals with and without PTSD were subjected to a Bonferroni adjustment in which the alpha level was set at 0.002. The presence of several ASD symptoms was significantly associated with a greater probability of having PTSD, recurrent images or thoughts, nightmares, distress on exposure, avoidance of thoughts, places and people, difficulty sleeping, poor concentration, exaggerated startle response, and motor restlessness. Individuals diagnosed with PTSD reported the abovementioned symptoms more often than individuals without a diagnosis of PTSD.


a The probability of the presence of PTSD when the symptom is present.

b The probability of the absence of PTSD when the symptom is absent.

\* *p* < 0.002.

\*\* *p* < 0.0001.

**Table 4.** Percentages of each ASD symptom on the basis of their PTSD diagnostic status (full and partial or no PTSD) and positive and negative predictive power of each symptom.

Both positive and negative predictive powers were moderate according to Cohen [29] for the following symptoms: afraid, hurt/death, helplessness, numbing, reduced awareness, derealization, depersonalization, dissociative amnesia, nightmares, avoidance of discussions, irritability, poor concentration, and hypervigilance. Negative predictive power was high while positive predictive power was moderate for recurrent thoughts or images, distress on exposure, avoidance of thoughts, avoidance of places, difficulty sleeping, and motor restlessness. Positive predictive power was high while negative predictive power was low for sense of reliving. Finally, both positive and negative predictive powers were high for avoidance of people and exaggerated startle response.

with and without PTSD were subjected to a Bonferroni adjustment in which the alpha level was set at 0.002. The presence of several ASD symptoms was significantly associated with a greater probability of having PTSD, recurrent images or thoughts, nightmares, distress on exposure, avoidance of thoughts, places and people, difficulty sleeping, poor concentration, exaggerated startle response, and motor restlessness. Individuals diagnosed with PTSD reported the abovementioned symptoms more often than individuals without a diagnosis of

**No PTSD** *χ***<sup>2</sup>**

**Table 4.** Percentages of each ASD symptom on the basis of their PTSD diagnostic status (full and partial or no PTSD)

Both positive and negative predictive powers were moderate according to Cohen [29] for the following symptoms: afraid, hurt/death, helplessness, numbing, reduced awareness, derealization, depersonalization, dissociative amnesia, nightmares, avoidance of discussions, irritability, poor concentration, and hypervigilance. Negative predictive power was high while

Hurt/death 96.7 86.4 1.90 0.60 0.75 Fear 96.7 90.9 0.77 0.59 0.67 Helplessness 83.3 77.3 0.30 0.60 0.50 Numbing 56.7 40.9 1.26 0.65 0.50 Reduced awareness 70.0 50.0 2.15 0.66 0.55 Derealization 86.7 68.2 2.60 0.63 0.64 Depersonalization 23.3 13.6 0.77 0.70 0.63 Dissociative amnesia 63.3 54.5 1.65 0.66 0.52 Recurrent images or thoughts 93.3 50.0 12.71\*\* 0.72 0.85 Nightmares 76.7 72.7 12.55\*\* 0.79 0.70 Sense of reliving experience 26.7 90.9 2.52 0.80 0.48 Distress on exposure 93.3 59.1 17.00\*\* 0.76 0.87 Avoidance of thoughts 100.0 54.5 21.27\*\* 0.75 1.00 Avoidance of discussions 60.0 77.3 7.148 0.78 0.59 Avoidance of places 93.3 45.5 10.76\* 0.70 0.83 Avoidance of people 93.1 72.7 23.74\*\* 0.82 0.89 Difficulty sleeping 96.7 63.6 22.49\*\* 0.78 0.93 Irritability 76.7 59.1 6.86 0.72 0.65 Poor concentration 86.7 50.0 8.314\* 0.70 0.73 Hypervigilance 93.3 18.2 1.649 0.61 0.67 Exaggerated startle response 90.0 77.3 24.27\*\* 0.84 0.85 Motor restlessness 90.0 61.9 15.46 0.77 0.81

**,1,** *n* **= 52 Positive predictive powera**

**Negative predictive**

**powerb**

PTSD.

a

b

\* *p* < 0.002. \*\* *p* < 0.0001.

**ASD symptom Full and partial**

**PTSD**

138 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

The probability of the presence of PTSD when the symptom is present.

The probability of the absence of PTSD when the symptom is absent.

and positive and negative predictive power of each symptom.

#### **3.4. Gender differences in the positive and negative predictive power of ASD clusters and symptoms on PTSD**

**Table 5** presents the proportion of women and men who reported each ASD symptom and cluster. Chi-squared analyses were conducted with a Bonferroni adjustment, *p* < 0.002. There were no significant differences in the presence of ASD symptoms and clusters between men and women. **Table 5** shows the positive and negative predictive power of each ASD symptom and cluster for men and women as a function of PTSD diagnostic status post trauma. Positive and negative predictive powers were similar for men and women for all clusters and symptoms.



a The probability of the presence of PTSD when the symptom is present.

b The probability of the absence of PTSD when the symptom is absent.

**Table 5.** Proportion of women and men reporting symptoms and predictive power of each ASD clusters and symptoms and gender differences.

### **4. Discussion**

To our knowledge, this is the first study to examine the predictive power of full and partial ASD diagnosis, clusters, and symptoms according to gender in victims of violent crimes. Results showed that 52% of victims met criteria for full ASD and 20% for partial ASD, while 40% met criteria for full PTSD and 17% for partial PTSD. Both full and partial ASD diagnoses, as well as all symptom clusters, and most symptoms, were predictive of PTSD. No gender differences were observed concerning the predictive power of ASD clusters and symptoms.

#### **4.1. ASD cases and incidence of PTSD**

In the present study, 60% of the participants who had a full diagnosis of ASD met full criteria for PTSD and 24% received a partial diagnosis of PTSD, compared to 89 and 11% in the Elklit and Brink study [18]. Of those with a partial ASD diagnosis, 55% met full criteria for PTSD and 18% met partial criteria for PTSD, compared to 51 and 46% in the previous study. Differences in the results could be attributable to the traumatic event experienced (i.e., bank robbery compared to violent crimes in our study) and the methodology used (i.e., questionnaires compared to clinical interviews in our study). Globally, these results showed that both full and partial ASD diagnoses are useful in predicting PTSD among victims of violent crimes. In both studies, partial ASD was attributed because cluster B for dissociation was not fulfilled. However, this situation is no longer an issue considering the decreased emphasis on dissociation in the DSM-5. Indeed, the fact that partial ASD is as good as full ASD to predict PTSD supports changes made in the DSM-5 not to require dissociative symptoms to meet criteria of PTSD.

#### **4.2. Predictive power of ASD diagnosis, clusters, and symptoms**

**ASD symptom Individuals meeting**

a

b

symptoms and gender differences.

**4.1. ASD cases and incidence of PTSD**

**4. Discussion**

**symptom/criterion**

140 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

**Female (***n* **= 39)**

**Male (***n* **= 36)**

The probability of the presence of PTSD when the symptom is present.

The probability of the absence of PTSD when the symptom is absent.

*χ***2 (df = 1)** 

Avoidance of places 77.8 71.8 0.35 0.65 0.75 0.75 0.88 Avoidance of people 65.7 64.1 0.02 0.80 0.83 0.88 0.90 Cluster E: arousal 91.7 94.9 0.31 0.64 0.59 1.00 1.00 Difficulty sleeping 72.2 76.9 0.22 0.82 0.75 1.00 0.88 Irritability 63.9 61.5 0.04 0.75 0.69 0.75 0.58 Poor concentration 69.4 79.5 1.00 0.75 0.67 0.75 0.71 Hypervigilance 88.9 87.2 0.05 0.64 0.58 1.00 0.50 Exaggerated startle response 58.3 69.2 0.97 0.92 0.79 0.81 0.88 Motor restlessness 77.8 60.5 2.57 0.74 0.81 1.00 0.73

**Table 5.** Proportion of women and men reporting symptoms and predictive power of each ASD clusters and

To our knowledge, this is the first study to examine the predictive power of full and partial ASD diagnosis, clusters, and symptoms according to gender in victims of violent crimes. Results showed that 52% of victims met criteria for full ASD and 20% for partial ASD, while 40% met criteria for full PTSD and 17% for partial PTSD. Both full and partial ASD diagnoses, as well as all symptom clusters, and most symptoms, were predictive of PTSD. No gender differences were observed concerning the predictive power of ASD clusters and symptoms.

In the present study, 60% of the participants who had a full diagnosis of ASD met full criteria for PTSD and 24% received a partial diagnosis of PTSD, compared to 89 and 11% in the Elklit and Brink study [18]. Of those with a partial ASD diagnosis, 55% met full criteria for PTSD and 18% met partial criteria for PTSD, compared to 51 and 46% in the previous study. Differences in the results could be attributable to the traumatic event experienced (i.e., bank robbery compared to violent crimes in our study) and the methodology used (i.e., questionnaires compared to clinical interviews in our study). Globally, these results showed that both full and partial ASD diagnoses are useful in predicting PTSD among victims of violent crimes. In both studies, partial ASD was attributed because cluster B for dissociation was not fulfilled. However, this situation is no longer an issue considering the decreased emphasis on dissociation in the DSM-5. Indeed, the fact that partial ASD is as good as full ASD to predict PTSD

**Positive predictive**

**Negative predictive**

**powerb**

**Male Female Male Female**

**powera**

In line with previous studies, ASD diagnosis showed the highest correct PTSD classification compared to each cluster. However, both positive and negative predictive powers were generally moderate, and each cluster was a relatively good predictor. Previous studies on victims of violent crimes found high negative predictive power (i.e., between 0.82 and 1.00) and low positive predictive power (i.e., between 0.22 and 0.39) for each cluster [4, 18–20]. Thus, the absence of a specific cluster (i.e., true negative) was more relevant in the prediction of PTSD diagnosis than the presence of that cluster (i.e., true positive). However, our results support the importance of both the presence and the absence of ASD clusters in predicting PTSD. The likelihood of developing PTSD without ASD seems weaker than when a victim is diagnosed with ASD. In the absence of acute stress reactions in the first days following trauma, it seems unlikely that posttraumatic stress symptoms appear. However, a partial or complete presence of ASD does not seem to systematically turn into PTSD, particularly due to the fact that coping strategies (e.g., seeking social support) set up by the victims following the violent crime may alter the psychopathological path of the individual.

Second, dissociation was not a better predictor compared to other clusters. These results may reflect differences between samples of victims of violent crimes and MVA. Indeed, a comparison study suggested that dissociation has a higher positive predictive power in samples of MVA compared to violent crimes (i.e., 0.71 and 0.61 compared with 0.33) [8]. MVA may induce more threatening stimuli (e.g., the sound of broken windows, risk of explosion, numerous smells), which may increase the risk of peritraumatic dissociation. Moreover, MVA occurs rapidly and suddenly, and victims may not have the time to react and to fully realize what is occurring, which may facilitate the onset of dissociative reactions. In studies on MVA, dissociation appears as an independent predictor of PTSD.

Contrary to previous studies on victims of MVA and burn injury [8, 21, 22], in our sample most symptoms had moderate to high positive and negative predictive powers, and were relatively good predictors of PTSD. As for clusters, our results support the pertinence of considering both the presence and the absence of ASD symptoms. Our findings on the predictive ability of ASD symptoms were similar to the ones obtained by Difede et al. [21] with the exception of nightmares and startle responses, which are more discriminative in victims of violent crimes, and reduced awareness, derealization, and irritability, which are more predictive of PTSD in burn victims. Similar to MVA, burn victims may be more at risk for dissociative reactions because of the rapid nature of the event and elevated risk of severe injury. They may also feel more irritable because of physical pain and the visibility of their burns.

#### **4.3. Gender differences in the predictive power of ASD clusters and symptoms**

Contrary to previous studies on MVA samples, our results revealed no gender differences in the predictive power of ASD on PTSD. Moreover, positive and negative predictive powers were similar for gender across all clusters and symptoms. Several factors could explain this absence of gender differences. In our sample, women and men reported similar percentages of ASD diagnosis (i.e., 51.3 and 52.8%, respectively) contrary to Bryant and Harvey [24] for MVA (i.e., 23 and 8%, respectively). In addition, in studies on MVA, dissociation was a better predictor in women, [8], but not in our study on victims of violent crimes. Indeed, a study found that dissociation was a better predictor for PTSD in women after an accidental traumatic event, but not after a violent crime [30]. Again, these findings highlight the potential indirect association between dissociation and PTSD in interpersonal traumatic events. Other factors may better explain gender differences in the prevalence of PTSD in victims of violent crimes. For instance, social support has been identified as a strongest effect size among several types of risk factors of PTSD (*d* = 0.28 and 0.40 [8, 24]). A study found that negative social interactions after a violent crime mediated the relation between gender and PTSD symptoms [3]. Hence, greater PTSD symptoms found in women were explained by more frequent negative social interactions.

#### **4.4. Research implications**

This study comprises several strengths, such as the examination of the positive and negative predictive powers of full and partial ASD diagnosis, clusters, and symptoms according to gender in victims of crimes. Moreover, ASD and PTSD were evaluated with validated semistructured interviews by trained assistants. Our results revealed that both full and partial ASD diagnoses are useful in predicting subsequent PTSD. Hence, our findings support the decision of the DSM-5 to decrease the emphasis on dissociative reactions to establish the ASD diagnosis. The prevalence of ASD was possibly underestimated in the DSM-IV because of the required dissociative symptoms [10], which were overly restrictive. As the decision to remove the dissociation requirement is the DSM-5 was not only based on ASD's power to predict PTSD, it remains to be seen whether this change could affect the prediction of PTSD. Henceforth, future studies could determine the ability of ASD to predict PTSD, with both diagnoses based on the new formulation of the DSM-5. Furthermore, findings indicate the usefulness of evaluating both the presence and the absence of each ASD cluster and most symptoms to better detect victims at risk for PTSD.

Interestingly, dissociation did not appear to be a better predictor of PTSD, in contradiction to studies on victims of MVA. Hence, future studies could examine the role of peritraumatic dissociation (i.e., during the trauma) compared to acute dissociation (i.e., within the first month following the trauma) in the prediction of PTSD. Persistent dissociation may imply ongoing dissociation reactions which negatively impact on the emotional processing of the traumatic experience [31], and may be more predictive of ASD and PTSD [32]. In fact, the restricted awareness aspect of acute dissociation was demonstrated to be the only significant predictor of PTSD variance [18]. In the same line, future studies could test the relation between persistent dissociation, PTSD, and risk factors such as childhood traumatic experiences. Moreover, contrary to studies on MVA victims, no gender differences were found in the predictive ability of ASD cluster and symptoms. Future studies could examine gender dimensions. Gender is culturally understood as a socially prescribed and experienced dimension of femaleness and maleness in a society, exemplified by gender roles [33]. Future studies could explore the relation between adherence to feminine and masculine characteristics and the expression of distress, symptoms, and the way individuals seek help after a traumatic event, using the Bem Sex Inventory [34]. Finally, future studies should examine the relation between ASD, PTSD, gender dimensions, and social support to better explain women's greater vulnerability for PTSD.

#### **4.5. Limitations**

were similar for gender across all clusters and symptoms. Several factors could explain this absence of gender differences. In our sample, women and men reported similar percentages of ASD diagnosis (i.e., 51.3 and 52.8%, respectively) contrary to Bryant and Harvey [24] for MVA (i.e., 23 and 8%, respectively). In addition, in studies on MVA, dissociation was a better predictor in women, [8], but not in our study on victims of violent crimes. Indeed, a study found that dissociation was a better predictor for PTSD in women after an accidental traumatic event, but not after a violent crime [30]. Again, these findings highlight the potential indirect association between dissociation and PTSD in interpersonal traumatic events. Other factors may better explain gender differences in the prevalence of PTSD in victims of violent crimes. For instance, social support has been identified as a strongest effect size among several types of risk factors of PTSD (*d* = 0.28 and 0.40 [8, 24]). A study found that negative social interactions after a violent crime mediated the relation between gender and PTSD symptoms [3]. Hence, greater PTSD symptoms found in women were explained by more frequent negative social

142 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

This study comprises several strengths, such as the examination of the positive and negative predictive powers of full and partial ASD diagnosis, clusters, and symptoms according to gender in victims of crimes. Moreover, ASD and PTSD were evaluated with validated semistructured interviews by trained assistants. Our results revealed that both full and partial ASD diagnoses are useful in predicting subsequent PTSD. Hence, our findings support the decision of the DSM-5 to decrease the emphasis on dissociative reactions to establish the ASD diagnosis. The prevalence of ASD was possibly underestimated in the DSM-IV because of the required dissociative symptoms [10], which were overly restrictive. As the decision to remove the dissociation requirement is the DSM-5 was not only based on ASD's power to predict PTSD, it remains to be seen whether this change could affect the prediction of PTSD. Henceforth, future studies could determine the ability of ASD to predict PTSD, with both diagnoses based on the new formulation of the DSM-5. Furthermore, findings indicate the usefulness of evaluating both the presence and the absence of each ASD cluster and most symptoms to better

Interestingly, dissociation did not appear to be a better predictor of PTSD, in contradiction to studies on victims of MVA. Hence, future studies could examine the role of peritraumatic dissociation (i.e., during the trauma) compared to acute dissociation (i.e., within the first month following the trauma) in the prediction of PTSD. Persistent dissociation may imply ongoing dissociation reactions which negatively impact on the emotional processing of the traumatic experience [31], and may be more predictive of ASD and PTSD [32]. In fact, the restricted awareness aspect of acute dissociation was demonstrated to be the only significant predictor of PTSD variance [18]. In the same line, future studies could test the relation between persistent dissociation, PTSD, and risk factors such as childhood traumatic experiences. Moreover, contrary to studies on MVA victims, no gender differences were found in the predictive ability of ASD cluster and symptoms. Future studies could examine gender dimensions. Gender is culturally understood as a socially prescribed and experienced dimension of femaleness and

interactions.

**4.4. Research implications**

detect victims at risk for PTSD.

The results of this study should be considered along with their limitations. It should be noted that our moderate sample size was associated with limited statistical power to detect significant effects, specifically for gender differences. Moreover, 31% of individuals did not complete both assessments. Victims were recruited within the 30 days following the crime, but the mean of 24 days is close to the maximum of 30 days allowed for establishing an ASD diagnosis and the minimum required for a PTSD diagnosis. In addition, a selection bias was possible because individuals referred to the research project may have been experiencing more difficulties and distress than usual. This fact may have decreased the potential of specific clusters of symptoms, such as dissociation, to predict PTSD.

#### **4.6. Clinical and policy implications**

The changes made to the diagnosis of ASD in the DSM-5 should allow for more distressed individuals, specifically those that previously had a partial ASD because of insufficient dissociative symptoms, to have access to mental health services. In spite of the fact that women are twice as likely as men to develop PTSD, our results suggest that screening both men and women for ASD after a violent crime is judicious. Moreover, some ASD symptoms were more predictive of PTSD. Thus, it seems relevant for clinicians to target these symptoms throughout the treatment to prevent the development of PTSD. Furthermore, it would be important to facilitate the access to psychological services, and to offer training to mental health providers in order to adequately screen for ASD using the DSM-5. Also, it would be pertinent to deliver evidence-based interventions. Indeed, trauma-focused cognitive behavioral therapy (CBT) for individuals with PTSD has been shown to be an efficient treatment to reduce PTSD symptoms [6]. Thus, it would be pertinent to test the effectiveness of an early brief preventive CBT for victims of crimes with ASD to prevent PTSD. This intervention has been shown to be efficient in female rape victims [35] but less so among victims of different violent crimes at long term [36].

### **5. Conclusion**

The present study highlights the importance of preventing PTSD in victims of violent crimes. Results indicate that ASD diagnosis, clusters, and symptoms appear pertinent to predict PTSD. Globally, findings support the DSM-5 decision regarding the decreased emphasis on dissociative reactions for an ASD diagnosis to better identify women and men at risk for PTSD. Hence, screening for ASD after a violent crime appears to be an appropriate measure to detect at-risk victims, and subsequently to deliver appropriate interventions in order to prevent the development of PTSD.
