Current Topics: A Clinical Perspective on Today’s Issues
Part 2
PTSD and Trauma
DSM-5 of PTSD
Criteria for people over the age of six
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more)
of the following ways
a. Directly experiencing the traumatic event(s).
b. Witnessing, in person, the event(s) as it occurred to others.
c. Learning that the traumatic event(s) occurred to a close family member or close
friend. In cases of actual or threatened death of a family member or friend, the
event(s) must have been violent or accidental.
d. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s)
B. Presence of one (or more) of the following intrusion symptoms
a. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
b. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
c. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if
the traumatic event(s) were recurring.
d. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic event(s).
e. Marked physiological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s)
a. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about
or closely associated with the traumatic event( s).
, b. Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or
feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or
more) of the following
a. Inability to remember an important aspect of the traumatic event(s)
b. Persistent and exaggerated négative beliefs or expectations about oneself, others,
or the world
c. Persistent, distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others
d. Persistent negative emotional state
e. Markedly diminished interest or participation in significant activities
f. Feelings of detachment or estrangement from others
g. Persistent inability to experience positive emotions
E. Marked alterations in arousal and reactivity associated with the traumatic events
a. Irritable behaviour and angry outbursts
b. Reckless or self-destructive behaviour
c. Hypervigilance.
d. Exaggerated startle response
e. Problems with concentration
f. Sleep disturbance
F. Duration of the disturbance for criteria B C D E is more than a month
G. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
H. The disturbance is not attributable to the physiological effects of a substance
Dissociative symptoms should be specified as either depersonalisation (detachment from the
body) or derealisation (unreality of surroundings). Delayed expression is the case when the full
criteria aren’t met until 6 months.
Posttraumatic Stress Disorder for Children 6 Years and Younger
, A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or
sexual violence in one (or more) of the following ways
a. Directly experiencing the traumatic event(s).
b. Witnessing, in person, the event(s) as it occurred to others, especially primary
caregivers.
c. Learning that the traumatic event(s) occurred to a parent or caregiving figure
B. Presence of one (or more) of the following intrusion symptoms
a. Recurrent, involuntary, and intrusive distressing memories
b. Recurrent distressing dreams
c. Dissociative reactions as if the traumatic event(s) were recurring
d. Intense or prolonged psychological distress at exposure to internal or external
cues
C. either persistent avoidance of stimuli associated with the traumatic event(s) or negative
alterations in cognitions and mood associated with the traumatic events
a. Persistent Avoidance of Stimuli
i. Avoidance of or efforts to avoid activities, places, or physical reminders
that arouse
ii. recollections of the traumatic event(s). Avoidance of or efforts to avoid
people, conversations, or interpersonal situations that arouse recollections
of the traumatic event(s).
b. Negative Alterations in Cognitions
i. Substantially increased frequency of negative emotional states
ii. Markedly diminished interest or participation in significant activities,
including constriction of play.
iii. Socially withdrawn behaviour.
iv. Persistent reduction in the expression of positive emotions
D. Alterations in arousal and reactivity associated with the traumatic events (two or more)
a. Irritable behaviour and angry outbursts typically expressed as verbal or physical
aggression toward people or objects.
b. Hypervigilance.
c. Exaggerated startle response.
Part 2
PTSD and Trauma
DSM-5 of PTSD
Criteria for people over the age of six
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more)
of the following ways
a. Directly experiencing the traumatic event(s).
b. Witnessing, in person, the event(s) as it occurred to others.
c. Learning that the traumatic event(s) occurred to a close family member or close
friend. In cases of actual or threatened death of a family member or friend, the
event(s) must have been violent or accidental.
d. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s)
B. Presence of one (or more) of the following intrusion symptoms
a. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
b. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
c. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if
the traumatic event(s) were recurring.
d. Intense or prolonged psychological distress at exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic event(s).
e. Marked physiological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s)
a. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about
or closely associated with the traumatic event( s).
, b. Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or
feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s),
beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or
more) of the following
a. Inability to remember an important aspect of the traumatic event(s)
b. Persistent and exaggerated négative beliefs or expectations about oneself, others,
or the world
c. Persistent, distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others
d. Persistent negative emotional state
e. Markedly diminished interest or participation in significant activities
f. Feelings of detachment or estrangement from others
g. Persistent inability to experience positive emotions
E. Marked alterations in arousal and reactivity associated with the traumatic events
a. Irritable behaviour and angry outbursts
b. Reckless or self-destructive behaviour
c. Hypervigilance.
d. Exaggerated startle response
e. Problems with concentration
f. Sleep disturbance
F. Duration of the disturbance for criteria B C D E is more than a month
G. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
H. The disturbance is not attributable to the physiological effects of a substance
Dissociative symptoms should be specified as either depersonalisation (detachment from the
body) or derealisation (unreality of surroundings). Delayed expression is the case when the full
criteria aren’t met until 6 months.
Posttraumatic Stress Disorder for Children 6 Years and Younger
, A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or
sexual violence in one (or more) of the following ways
a. Directly experiencing the traumatic event(s).
b. Witnessing, in person, the event(s) as it occurred to others, especially primary
caregivers.
c. Learning that the traumatic event(s) occurred to a parent or caregiving figure
B. Presence of one (or more) of the following intrusion symptoms
a. Recurrent, involuntary, and intrusive distressing memories
b. Recurrent distressing dreams
c. Dissociative reactions as if the traumatic event(s) were recurring
d. Intense or prolonged psychological distress at exposure to internal or external
cues
C. either persistent avoidance of stimuli associated with the traumatic event(s) or negative
alterations in cognitions and mood associated with the traumatic events
a. Persistent Avoidance of Stimuli
i. Avoidance of or efforts to avoid activities, places, or physical reminders
that arouse
ii. recollections of the traumatic event(s). Avoidance of or efforts to avoid
people, conversations, or interpersonal situations that arouse recollections
of the traumatic event(s).
b. Negative Alterations in Cognitions
i. Substantially increased frequency of negative emotional states
ii. Markedly diminished interest or participation in significant activities,
including constriction of play.
iii. Socially withdrawn behaviour.
iv. Persistent reduction in the expression of positive emotions
D. Alterations in arousal and reactivity associated with the traumatic events (two or more)
a. Irritable behaviour and angry outbursts typically expressed as verbal or physical
aggression toward people or objects.
b. Hypervigilance.
c. Exaggerated startle response.
