there were three major symptom clusters in DSM-IV—reexperiencing, avoidance/numb-
ing, and arousal—there are no w four symptom clusters in DSM-5, because the avoidance/
numbing cluster is divided into two distinct clusters: avoidance and persistent negative al-
terations in cognitions and mood. This latter  category, which retains most of the DSM-IV
numbing symptoms, also includes new or re conceptualized symptoms, such as persistent
negative emotional states. The final cluster— alterations in arousal and reactivity—retains
most of the DSM-IV arousal symptoms. It also includes irritable behavior or angry out-
bursts and reckless or self-destructive beha vior. PTSD is now develo pmentally sensitive in
that diagnostic thresholds have been lowe red for children and adolescents. Furthermore,
separate criteria have been added for childre n age 6 years or younger with this disorder.
The DSM-IV childhood diagno sis reactive attachment di sorder had two subtypes:
emotionally withdrawn/inhibited and indiscri minately social/disinhibited. In DSM-5,
these subtypes are defined as distinct disorders: reactive attachment disorder  and disin-
hibited social engagement disorder.
Dissociative Disorders
Major changes in dissociative disorders in DS M-5 include the following: 1) derealization is
included in the name and symptom structure of what previously was called depersonali-
zation disorder ( depersonalization/derealization disorder ); 2) dissociative fugue is now a
specifier of dissociative amnesia rather than a separate diagnosis, and 3) the criteria for
dissociative identity disorder  have been changed to indicate that symptoms of disruption
of identity may be reported as well as observed, and that gaps in the recall of events may