Post-Traumatic Stress Disorder

What is PTSD?

Criteria for PTSD In the Diagnostic and Statistical

Manual of Mental Disorders (DSM-IV-TR), revised in 2000, sets forth five criteria for diagnosing PTSD.• A. Stressor• B. Intrusive recollection• C. Avoidant/numbing• D. Hyper-arousal• E. Duration• F. Functional significance

Stressors A stressor is a traumatic event in

which included both of the following:• Experiencing, witnessing, or being

confronted with an event that involves actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

• The response to the event involved intense fear, helplessness, or horror.

There are many types of stressors.

Combat Situations including

danger to safety or life, witnessing death and injury, making life and death decisions, or high stress working conditions with long hours and unsafe conditions.

These conditions may also apply to medical teams, fire fighters, police force, rescue squad .

Natural Disaster A natural

catastrophe such as an earthquake, fire, flood, hurricane, tornado, volcano, landslide or a dangerous dust storm / windstorm.

Also other disasters, such as explosions or chemical spills.

Motor Vehicle Accident Being seriously

injured or seeing someone else be seriously injured or killed in an automobile, airplane, or other such accident.

Violent Crime Physical assault (any

form of physical contact intended to intimidate or cause pain.

Sexual assault (by a stranger, family member, or anyone else).

Being threatened with a weapon.

Domestic Violence/Abuse Being physically,

sexually, or emotionally maltreated by a parent or spouse.

Being confined or deprived of nutrition or medical care.

Witnessing violence among family members.

Intrusive Recollection Recurrent and intrusive distressing recollections of the

event, including images, thoughts, or perceptions. Recurrent distressing dreams of the event. Acting or feeling as if the traumatic event were recurring

• includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated.

Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Avoidant/Numbing Persistent avoidance of stimuli associated with the

trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:• Efforts to avoid thoughts, feelings, or conversations associated

with the trauma• Efforts to avoid activities, places, or people that arouse

recollections of the trauma• Inability to recall an important aspect of the trauma• Markedly diminished interest or participation in significant

activities• Feeling of detachment or estrangement from others• Restricted range of affect (e.g., unable to have loving feelings)• Sense of foreshortened future (e.g., does not expect to have a

career, marriage, children, or a normal life span)

Hyper-arousal Persistent symptoms of increasing

arousal (not present before the trauma), indicated by at least two of the following:• Difficulty falling or staying asleep• Irritability or outbursts of anger• Difficulty concentrating• Hyper-vigilance• Exaggerated startle response

Duration Duration of the

disturbance (intrusive recollection, avoidant/numbing, hyper-arousal) is more than one month.• Acute: if duration of

symptoms is less than three months

• Chronic: if duration of symptoms is three months or more

Functional Significance The disturbance causes clinically

significant distress or impairment in social, occupational, or other important areas of functioning.

Delayed Onset Delayed onset occurs if onset of

symptoms is at least six months after the stressor.

Denial or repression of an incident immediately after the fact may be the cause of delayed onset of symptoms.

References American Psychiatric Association. (2000). Diagnostic and

statistical manual of mental disorders DSM-IV-TR ( Fourth ed.). Washington D.C.: American Psychiatric Association.

network, a. (2005). What is Traumatic Enough for PTSD? Retrieved January 20, 2010, from PTSD forum: promoting growth through healing: http://www.ptsdforum.org/content.php?r=266-What-is-Traumatic-Enough-for-PTSD

U.S. Department of Veterans Affairs. (2009, November 9). DSM-IV-TR criteria for PTSD. Retrieved January 20, 2010, from National Center for PTSD: http://www.ptsd.va.gov/professional/pages/dsm-iv-tr-ptsd.asp