Statement of Principles concerning posttraumatic stress disorder (Reasonable Hypothesis) (No. 97 of 2022) (Cth)

Statement of Principles concerning POSTTRAUMATIC STRESS DISORDER (Reasonable Hypothesis) (No. 97 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 21 October 2022

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM Chairperson

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions

1 Name This is the Statement of Principles concerning posttraumatic stress disorder (Reasonable Hypothesis) (No. 97 of 2022). 2 Commencement This instrument commences on 21 November 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning posttraumatic stress disorder No.82 of 2014 (Federal Register of Legislation No. F2014L01144) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about posttraumatic stress disorder and death from posttraumatic stress disorder. Meaning of posttraumatic stress disorder (2) For the purposes of this Statement of Principles, posttraumatic stress disorder means a disorder of mental health which meets the following criteria (derived from DSM-5-TR): 1. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: (i) directly experiencing the traumatic event(s); (ii) witnessing, in person, the event(s) as it occurred to others; (iii) learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental; or (iv) experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (for example, first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This criterion does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related; and B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: (i) recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children older than six years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed; (ii) recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). In children, there may be frightening dreams without recognisable content; (iii) dissociative reactions (for example, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) In children, trauma-specific reenactment may occur in play; (iv) intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event(s); or (v) marked physiological reactions to internal or external cues that symbolise or resemble an aspect of the traumatic event(s); and C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: (i) avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); or (ii) avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); and D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: (i) inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs); (ii) persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (for example, "I am bad", "None can be trusted", "The world is completely dangerous", "My whole nervous system is permanently ruined"); (iii) persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others; (iv) persistent negative emotional state (for example, fear, horror, anger, guilt, or shame); (v) markedly diminished interest or participation in significant activities; (vi) feelings of detachment or estrangement from others; or (vii) persistent inability to experience positive emotions (for example, inability to experience happiness, satisfaction, or loving feelings); and E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: (i) irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects; (ii) reckless or self-destructive behaviour; (iii) hypervigilance; (iv) exaggerated startle response; (v) problems with concentration; or (vi) sleep disturbance (for example, difficulty falling or staying asleep or restless sleep); and F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month; and G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and H. The disturbance is not attributable to the physiological effects of a substance (for example, medication, alcohol) or another medical condition. Note: DSM-5-TR is defined in the Schedule 1 – Dictionary.