What Is PTSD?

This may seem redundant to some people but I want to go over the basic details of what PTSD (Post-Traummatic Stress Disorder) is.  It is important to know what it is according to medical diagnosis instead of by word of mouth.  PTSD is diagnosed by a psychologist or psychiatrist.  If a primary care provider suspects PTSD, he or she should give a referral to a mental health care provider.  How PTSD is diagnosed is using the Diagnostics and Statistics Manual, more commonly referred as the DSM-5.  This manual is updated approximately every ten years.  The fifth volume, the most current, was published in 2013.  In this manual, PTSD has added additional criteria for being diagnosed with this disorder.  Here is the breakdown:

Criteria A: Stessor

The person was exposed to a trauma which may include abuse, violence, death, life threatening situation, and/or serious injury.  At least one of the following is required:

1. Direct exposure

2. Witnessing, in person.

3. Indirectly, by learning a close relative or friend was exposed to a trauma.  If the event involved an actual or threatened death, it must have been violent or accidental.

4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.


Criteria B: Intrusion Symptoms

The traumatic event is re-experienced persistently.  One of the following is required:

1. Recurrent, intrusive, and involuntary memories.

2. Traumatic nightmares.

3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness.   (my personal note: this symptom is also associated with feeling like in a "fog" or feeling "cloudy headed".  Memory loss is also associated with this symptom)

4. Intense and/or prolong distress after exposure to traumatic reminders (my personal note: this is often associated with "triggers".  An example of this would be the backfire of a vehicle, fireworks, movies, conversations, etc.  Anything associated with the trauma.).

5. Marked physiological reactivity after the exposure of a trauma related stimuli (my personal note: The following are examples of this symptom: hitting the ground "cover", flinching, shaking, etc.)


Criteria C: Avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event.  One of the following is required:

1. Trauma related thoughts or feelings.

2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

(My personal note: Criteria C is listed more complicated than it really is.  If the person is avoiding anything that reminds them of the traumatic even or even if they think it may remind them, the person meets the requirement.)


Criteria D: Negative Alterations in Cognitions and Mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event.  Two of the following are required:

1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).

2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").

3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.

4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).

5. Markedly diminished interest in (pre-traumatic) significant activities.

6. Feeling alienated from others (e.g., detachment or estrangement).

7. Constricted affect: persistent inability to experience positive emotions.


Criteria E: Alterations in Arousal and Reactivity

Trauma related alterations in arousal and reactivity that began or worsened after the traumatic event.  Two of the following are required:

1. Irritability or aggressive behavior.

2. Self-destructive or reckless behavior.

3. Hypervigilance 

4. Exaggerated startled response (my personal note: this goes hand in hand with the Criteria B:Intrusive Symptoms, number 4.)

5. Problems with concentration.

6. Sleep disturbances (my personal note: this also goes hand in hand with Criteria B: Intrusive Symptoms, number 2.  This can also be associated with Criteria C: Avoidance if the person has insomnia due to avoiding nightmares).


Criteria F: Duration

Persistence of symptoms in Criteria B, C, D, and E for more than one month.  (my personal note: There is no time frame when the symptoms might present themselves.  It may be immediately after the trauma or decades afterward.)


Criteria G: Functional Significance

Significant symptom-related distress or functional impairment (e.g., social, occupational). (my personal note: This can also include the inability to socially interact with friends, impacting family functioning, impact at work, inability to handle crowds, etc.  This portion is typically hard for the person with PTSD to recognize since it becomes routine to function this way).


Criteria H: Exclusion 

Disturbance is not due to medications, substance abuse, or any other illness.



Dissociative Symptoms:

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

Delayed Expression:
Full diagnosis is not met until at least six months after the trauma, although onset of symptoms may appear immediately.


There are other types of PTSD but they have not been accepted into the DSM-V.  More on that soon....  Please comment with any questions you may have or comments.