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PTSD:Diagnosis & evaluation

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Diagnostic CriteriaEdit

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). Post-traumatic stress disorder (PTSD), recognised since 1980 when it was in included as a distinct diagnostic category in the DSM-III (APA, 1980), is a condition that follows an unusually threatening event which, in most instances, is sudden and catastrophic in proportion. It is characterised by;

“… the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma” (DSM-IV, APA, 1995; p.403)

Diagnosis of the condition requires a number of factors to be present in each of the following six symptom categories (as outlined in DSM-IV, 1995);

A. The person has been the victim of, or has been exposed to a traumatic event which involved threatened death or serious injury, or the death of others. The person’s response involved intense fear, helplessness or horror.

B. The person persistently reexperiences the traumatic event through, for example, nightmares, dissociative flashback episodes, intrusive re-collections of the event etc.

C. The person persistently avoids stimuli associated with the trauma (e.g. avoidance of places or people that arouse recollections of the trauma) and experiences numbing of general responsiveness (e.g. restricted range of affect, feelings of detachment or estrangement from others).

D. The person experiences persistent symptoms hyperarousal (e.g. difficulty falling or staying asleep, increased irritability, exaggerated startle response).

E. The duration of the disturbance is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Symptoms and their possible explanationsEdit

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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