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PTSD:Diagnosis & evaluation

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Diagnostic Criteria

The diagnostic criteria for PTSD, according to Diagnostic and Statistical Manual of Mental Disorders -IV (DSM-IV), are stressors listed from A to F.

Due to copyright issues and editorial concerns the reference to the DSM-IV-TR is outlinked. The current diagnostic criteria for the PTSD published in the Diagnostic and Statistical Manual of Mental Disorders may be found here:

DSM-IV-TR Diagnostic Criteria: Post-traumatic stress disorder

Notably, the stressor criterion A is divided into two parts. The first (A1) requires that "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." The second (A2) requires that "the person’s response involved intense fear, helplessness, or horror." The DSM-IV A criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience." Since the introduction of DSM-IV, the number of possible PTSD-traumas has increased, and one study suggests that the increase is around 50% (Breslau & Kessler 2001).

Symptoms and their possible explanations

Symptoms can include general restlessness, insomnia, aggressiveness, depression, dissociation, emotional detachment, or nightmares. A potential symptom is the memory loss about an aspect of the traumatic event. Amplification of other underlying psychological conditions may also occur. Young children suffering from PTSD will often enact aspects of the trauma through their play, and may often have nightmares that lack any recognizable content.

One patho-psychological way of explaining PTSD is by viewing the condition as secondary to deficient emotional or cognitive processing of a trauma (Cordova 2001). This view also helps to explain the three symptom clusters of the disorder (Shalev 2001):

Intrusion: Since the sufferer cannot process difficult emotions in a normal way, they are plagued by recurrent nightmares, or daytime flashbacks, while realistically re-experiences the trauma. These re-experiences are characterized by high anxiety levels, and make up one part of the PTSD symptom cluster triad called intrusive symptoms.

Hyperarousal: PTSD is also characterized by a state of nervousness with the organism being prepared for "fight or flight". The typical hyperactive startle reaction, characterized by "jumpiness" in connection with high sounds or fast motions, is typical for another part of the PTSD cluster called hyperarousal symptoms, and could also be secondary to an incomplete processing.

Avoidance: The hyperarousal and the intrusive symptoms are eventually so distressing that the individual strives to avoid contact with everything, and everyone, even to their own thoughts, that can arouse memories of the trauma and thus cause the intrusive and hyperarousal states to go on. The suffer isolates themselves, becoming detached in their feelings with a restricted range of emotional response, and can experience so-called emotional detachment ("numbing"). This avoidance behavior is the third and most important part of the symptom triad that makes up the PTSD criteria.

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