Post-traumatic stress disorder is characterized by the development of specific symptoms following exposure to a traumatic event in a context of death, death threats, serious injury, or threat to life or physical integrity. Exposure to the event may be direct or indirect (e.g., witness or learn that a loved one has been exposed).
The symptoms of Post Traumatic Stress Disorder fall into four categories:
- A tendency to relive the event (e.g., invasive, involuntary, spontaneous, and recurrent memories of the traumatic event, nightmares)
- A tendency to avoid (e.g., avoidance of thoughts, feelings, places or persons that cause recall of the traumatic event)
- Cognitive and emotional alterations (e.g., persistent blame, negative perception of self, others, or the world)
- Hyper-arousal (e.g., exaggerated startled reactions, hypervigilance)
These symptoms must persist for more than one month after the event and cause suffering or impaired functioning.
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The DSM-5 (American Psychological Association, 2013)1 provides 8 criteria for diagnosing Post Traumatic Stress Disorder:
Criterion A: Exposure to actual death or threat of death, serious injury or sexual violence.
Criterion B: Invasive symptoms associated with the event (reliving the trauma)
- Repetitive, involuntary, and pervasive remembering of the event generating distress
- Repetitive dreams causing a sense of distress in connection with the event
- Dissociative reactions (e.g., flashbacks)
- Severe and prolonged feelings of distress when exposed to internal or external cues that evoke or resemble the event
- Physiological reactions when exposed to internal or external cues that evoke or resemble the event
Criterion C: Persistent avoidance of stimuli associated with the event
- Avoidance of memories, thoughts, or feelings related to the event
- Avoidance of external stimuli (people, places, conversations) that elicit memories of the event
Criterion D: Negative alterations in cognition and mood associated with the event
- Inability to remember an important aspect of the event
- Negative and exaggerated beliefs or expectations (of themselves, others, or the world)
- Persistent cognitive distortions about the cause or consequences of the event that cause the subject to blame or blame others
- Persistent negative emotional state
- Net reduction of interest in important activities or reduction of participation
- Feelings of emotional detachment or remoteness
- Persistent inability to feel positive emotions
Criterion E: Significant alterations in the level of arousal and responsiveness associated with the event
- Irritability, tantrums, verbal / physical aggression
- Unwise / self-destructive behaviors
- Exaggerated startled response
- Concentration problems
- Sleep problems
Criterion F: The disturbance lasts more than a month
Criterion G: The disturbance is not attributable to the physiological effects of a substance or another medical condition.
In children under 6, the criteria for diagnosing post-traumatic stress disorder vary from those in adults (see DSM-5, American Psychological Association, 2013)
Following a traumatic event, Post Traumatic Stress Disorder rarely occurs alone. Thus, 60-75% of people with Post Traumatic Stress Disorder have associated disorders that need to be considered in the treatment plan (Kessler, Sonnega, Bromet, Hughes & Nelson, 1995)3. The most common comorbid symptomatologies include depression (48% of Post Traumatic Stress Disorder victims, Kessler et al., 1995)4 with increased suicidal risk, substance abuse (alcohol abuse in 52% of men and 28% of women, drug abuse in 35% of men and 27% of women, Kessler et al., 1995)5, and anxiety disorders (generalized anxiety in 17%, panic attack in 7%, Kessler et al., 1995)6.