New York State Medical Treatment Guidelines for Diagnosis in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer general principles for the diagnosis of medical conditions. These directives aim to assist healthcare professionals in determining appropriate strategies for identifying and confirming specific health issues as part of a comprehensive assessment.

Healthcare practitioners specializing in diagnosis can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for accurately diagnosing conditions in their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding diagnosis should involve collaboration between the patient and their healthcare provider.

Diagnostic Criteria for ASD


DSM-5 Diagnostic Criteria for ASD

Criterion A: Facing the Unthinkable

In Criterion A, we’re talking about being exposed to the kind of stuff that shakes you to your core—actual or threatened death, serious injury, or sexual violence. This exposure can happen in a few ways:

  1. Being Right There: Going through the traumatic event yourself.
  2. Seeing it Live: Watching the event unfold in front of your eyes.
  3. Close to Home: Hearing that someone really close to you, like family or a dear friend, went through it. Just a note, if it’s about the actual or threatened death of a loved one, it needs to be a violent or accidental event.
  4. Constant Reminder: Dealing with the nitty-gritty details of the traumatic event over and over again. For example, think of first responders who have to handle human remains or police officers constantly exposed to the grim specifics of child abuse. But, and this is important, it doesn’t count if you saw it on the news or in pictures—unless, of course, that exposure is tied to your work.


Criterion B Facing the Unthinkable: Meeting the Standard

In this criterion, we’re delving into experiences that hit you hard—real or potential death, serious injury, or sexual violence. These situations can unfold in a few ways:

  1. Personal Experience: Going through the tough event yourself.
  2. Live Witness: Watching the event happen right before your eyes.
  3. Close to Heart: Learning that someone super close, like family or a dear friend, went through it. Quick heads up, if it involves the actual or threatened death of a loved one, it has to be a violent or accidental incident.
  4. Reliving it: Handling the gritty details of the traumatic event repeatedly. Picture first responders dealing with human remains or police officers constantly facing the harsh specifics of child abuse. But here’s the kicker—seeing it on the news or in pictures doesn’t count, unless, of course, it’s tied to your job.

Struggling Emotionally:

Feeling the Blues:
5. It’s tough to feel the good stuff—like happiness, satisfaction, or love. Positive emotions just don’t seem to stick around.

Getting Lost in Thoughts:
6. Sometimes, the way we see things changes, like looking at ourselves from someone else’s view, feeling a bit spaced out, or time seeming to slow down.

Memory Gaps:
7. There might be bits of the event that we just can’t remember, not because of a knock to the head, alcohol, or drugs, but due to something called dissociative amnesia.

Dodging the Tough Stuff:
8. We try to steer clear of memories, thoughts, or feelings that bring us distress about or remind us of the tough event.

Avoiding Triggers:
9. External reminders become no-go zones—people, places, chats, activities, objects, situations that bring back those tough memories, thoughts, or feelings.

A Rollercoaster of Rest:
10. Sleep becomes a challenge—trouble falling asleep, staying asleep, or restless nights become the norm.

On Edge:
11. Irritability and explosive anger, often without much reason, can show up, directed at people or things.

Staying Alert:
12. We’re always on the lookout—hypervigilance kicks in, making us super aware and cautious.

Mind in a Whirl:
13. Concentrating becomes a battle—we can’t seem to focus on things like we used to.

Jumpy Reactions:
14. Small things make us jump out of our skin—our startle response is cranked up a notch.


Criterion C: Riding Out the Storm

When it comes to how long the storm lasts (those symptoms we talked about in Criterion B), we’re looking at a timeframe of three days to one month after facing the trauma. Just to clarify, the symptoms usually kick in right after the tough experience, but to meet the criteria for this disorder, they need to stick around persistently for at least three days and up to a month.

Criterion D: Feeling the Impact

Now, let’s talk about the aftermath. The disruption caused by these symptoms needs to hit hard—bringing about noticeable distress or getting in the way of everyday life, whether in social situations, at work, or in other crucial areas of functioning.

Criterion E: Ruling Out Other Culprits

We also need to rule out other possible explanations. This disturbance can’t be blamed on the effects of substances like medication or alcohol, or another medical condition like a mild traumatic brain injury. And, to top it off, it shouldn’t align better with a brief psychotic disorder.


DSM-5 Diagnostic Criteria for PTSD

Criterion A: Facing Life’s Darkest Moments

Let’s dive into what sets off this whole experience:

  1. Personal Encounter: Going through the traumatic events yourself.
  2. Eyewitness Account: Being there in person, watching the events unfold.
  3. Close Ties: Hearing that someone very dear, like family or a close friend, went through it. Quick heads up, if it involves the actual or threatened death of a loved one, it has to be a violent or accidental incident.
  4. Repetitive Exposure: Dealing with the gritty details of the traumatic events over and over again. Picture first responders handling human remains or police officers repeatedly dealing with the harsh specifics of child abuse. Oh, and just so we’re clear, exposure through electronic media, TV, movies, or pictures doesn’t count—unless it’s tied to your job.


Criterion B: Living with the Aftermath

Now, let’s talk about what happens after going through the tough stuff:

  1. Unwanted Memories: Dealing with distressing memories of the traumatic event(s) that keep popping up, even when you don’t want them to.
  2. Disturbing Dreams: Nights filled with distressing dreams where the content and feelings are all tied to the traumatic event(s).
  3. Flashbacks: Moments of dissociation, like flashbacks, where it feels or seems like the traumatic event(s) are happening again. It can range from feeling a bit disconnected to completely losing touch with the present.
  4. Emotional Overload: Feeling intense and lasting emotional distress when faced with anything that reminds you of the traumatic event(s), whether it’s from inside or outside.
  5. Physical Reactions: Your body reacting strongly—physiologically—to anything that brings back memories of the traumatic event(s), whether it’s from inside or outside.


Criterion C: Steering Clear of the Painful Reminders

Now, let’s talk about how things change afterward:

  1. Memory Block: Trying hard to steer clear of distressing memories, thoughts, or feelings tied to the traumatic event(s). It’s like putting up mental barricades to keep those tough memories at bay.
  2. Avoidance Tactics: Doing whatever it takes to dodge external reminders—whether it’s avoiding certain people, places, talks, activities, objects, or situations—that bring back those distressing memories and feelings tied to the traumatic event(s). It’s a way of creating a protective bubble around yourself.


Criterion D: The Inner Shift

Now, let’s delve into the changes that happen inside:

  1. Memory Gaps: Having trouble remembering a crucial part of the traumatic event(s). It’s not just a casual forgetfulness; it’s more like a mental block, often tied to dissociative amnesia rather than other factors like a bump on the head, alcohol, or drugs.
  2. Negative Outlook: Carrying around persistent and magnified negative beliefs or expectations about yourself, others, or the world. It’s like having a dark cloud over your thoughts, with beliefs like “I am bad,” “No one can be trusted,” “The world is completely dangerous,” or “My whole nervous system is permanently ruined.”
  3. Blaming Game: Stuck with ongoing distorted thoughts about what caused the traumatic event(s) or its consequences, leading to self-blame or blaming others.
  4. Emotional Strain: Living with a constant, heavy emotional burden—fear, horror, anger, guilt, shame—that just won’t let up.
  5. Lost Passions: Finding it hard to engage or enjoy significant activities that once brought joy or fulfillment.
  6. Isolation Feels: Experiencing a sense of detachment or estrangement from others, like you’re on the outside looking in.
  7. Joy Block: Struggling with a persistent inability to feel positive emotions—happiness, satisfaction, loving feelings—that used to light up your life.

Criterion E: Riding the Emotional Rollercoaster

Now, let’s talk about the rollercoaster of emotions that kick in:

  1. Irritable Explosions: Dealing with sudden fits of irritability and bursts of anger, sometimes even when there’s no apparent reason. It’s like emotions boiling over, expressed through verbal or physical aggression towards people or objects.
  2. Risk-Taking Tendencies: Engaging in risky or self-destructive behaviors, as if trying to navigate the turbulence of emotions by taking daring leaps.
  3. Constant Watchfulness: Being on high alert all the time—hypervigilance—keeping an eye out for potential threats or dangers, even in seemingly safe situations.
  4. Jumpy Reflex: Experiencing an exaggerated startle response, like your nerves are constantly on edge, making you react more intensely than usual to sudden stimuli.
  5. Focus Fluctuations: Battling with concentration issues, finding it hard to stay focused or process information smoothly.
  6. Sleep Struggles: Wrestling with sleep disturbances—trouble falling asleep, staying asleep, or enduring restless nights. It’s like a constant struggle to find rest in the midst of inner turbulence.


Criterion F: Living with the Aftermath

Now, let’s dive into the aftermath and how long it lingers:

Living with the Impact: The effects of the traumatic event(s) stretch beyond the initial shock, sticking around for more than a month. It’s like an enduring echo of the distressing symptoms outlined in Criteria B, C, D, and E, becoming a part of daily life.


Criterion G: Life on the Edge

Now, let’s talk about the impact on day-to-day life:

Walking a Tightrope: The aftermath of the traumatic event(s) isn’t just a personal struggle; it spills over into social, work, and other crucial parts of life. It’s like walking a tightrope, with the disturbance causing noticeable distress or getting in the way of how you function in these essential areas. It’s not just about surviving; it’s about finding a balance in the midst of it all.


DSM-IV versus DSM-5: Clinical Practice Guideline Implications

The criteria for diagnosing PTSD saw significant revisions from the DSM-IV, released in 1994, to the DSM-5, published in 2013. If an individual was diagnosed with PTSD under the DSM-IV before the DSM-5 criteria were introduced, the PTSD Treatment Guidelines provided here are applicable to their care. For diagnoses made after the publication of DSM-V criteria, the diagnosis of PTSD should align with the criteria outlined in the DSM-V. In essence, if an injured worker previously received a PTSD diagnosis under DSM-IV, that diagnosis remains valid, and their care should adhere to the guidelines outlined here.

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