LECTURE 6 – PTSD
DSM-5;
- A: Exposure to actual or threatened death, serious injury, or sexual violence in one
(or more) of the following ways:
- Directly witnessing the event
- Witnessing in person the event as it happens to others
- Learning that the event occurred to a close family member or close friend. In cases
of actual or threatened death of a family member or friend, the events must have
been violent or accidental
- Experiencing repeated or extreme exposure to aversive details of the event (e.g. first
responders collecting human remains, officers repeatedly exposed to details of child
abuse)
- Note: the final criterion does not apply to exposure through media, TV, movies, or
pictures, unless the exposure is work-related
- B: Prescence of one (or more) of the following intrusion symptoms associated with
the events, starting after the event occurred:
- Recurrent, involuntary and distressing memories of the event
- Recurrent distressing dreams in which the content or affect of the dreams are
related to the event
- Dissociative reactions (flashbacks) in which the individual feels or acts as if the
traumatic events were recurring
- Intense or prolonged psychological distress at exposure to internal or external cues
that resemble an aspect of the event
- Marked physiological reactions to internal or external cues that resemble an aspect
of the event
- C: Persistent avoidance of stimuli associated with the event, beginning after the
event occurred, as evidenced by one or both of the following:
- Avoidance of, or efforts to, avoid distressing memories, thoughts, or feelings about,
or closely associated with traumatic events
- Avoidance of, or efforts to, avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or feelings
about or associated with the event
- D: Negative alterations in cognition and mood associated with the event, beginning,
or worsening after the event, evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event (due to
dissociative amnesia not head injuries or other reason)
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or
of the world
- Persistent, distorted cognitions about the cause or consequences of the event that
leads to self-blame, or blame on others
- Persistent negative emotional state
- Markedly diminished interest or participation in activities
- Feelings of detachment from others
- Persistent inability to experience positive emotions
, - E: Marked alterations in arousal and reactivity associated with the traumatic event,
beginning or worsening after the event occurred, evidenced by two or more of the
following:
- Irritable behaviour and angry outbursts with little to no provocation, typically
expressed as verbal or physical aggression
- Reckless or self-destructive behaviour
- Hyper-vigilance
- Exaggerated startle response
- Problems concentrating
- Sleep disturbances
- F: the duration of B, C, D, & E is more than one month
- G: the disturbance causes clinically significant distress or impairment in social,
occupational, or other important area of functioning
- H: the disturbance is not attributable to substances (meds, alcohol, drugs) or another
medical condition
ICD-10;
- A: The patient must have been exposed to a stressful event or situation of
exceptionally threatening or catastrophic nature, which would likely cause pervasive
distress in anyone
- B: There must be persistent remembering or “reliving” of the stressor in intrusive
flashbacks, vivid memories, or recurring dreams, or experiencing distress when
exposed to circumstances resembling the stressor
- C: The patient must exhibit an actual or preferred avoidance of circumstances
resembling the stressor which was not present before exposure to the stressor
- D: Either of the following must be present:
- 1) Inability to recall, either partially or completely, some important aspects of the
period of exposure
- 2) Persistent symptoms of increased psychological sensitivity and arousal not
present before the stressor, shown by any two of the following:
- Difficulty falling or staying asleep
- Irritability or outburst of anger
- Difficulty in concentrating
- Hypervigilance
- Exaggerated startle response
- E: Criteria B, C & D must all be met within 6 months of the event. For some purposes,
onset delayed more than 6 months may be included, but this should be clearly
specified.
Links to Violence & Crime
PTSD and crime;
- Predominately research focuses on war veterans
- Newer studies starting to look at general pop/forensic samples, but needs more
work done!
- Typically most studies on PTSD & crime are in terms of the victims, not the perps!
DSM-5;
- A: Exposure to actual or threatened death, serious injury, or sexual violence in one
(or more) of the following ways:
- Directly witnessing the event
- Witnessing in person the event as it happens to others
- Learning that the event occurred to a close family member or close friend. In cases
of actual or threatened death of a family member or friend, the events must have
been violent or accidental
- Experiencing repeated or extreme exposure to aversive details of the event (e.g. first
responders collecting human remains, officers repeatedly exposed to details of child
abuse)
- Note: the final criterion does not apply to exposure through media, TV, movies, or
pictures, unless the exposure is work-related
- B: Prescence of one (or more) of the following intrusion symptoms associated with
the events, starting after the event occurred:
- Recurrent, involuntary and distressing memories of the event
- Recurrent distressing dreams in which the content or affect of the dreams are
related to the event
- Dissociative reactions (flashbacks) in which the individual feels or acts as if the
traumatic events were recurring
- Intense or prolonged psychological distress at exposure to internal or external cues
that resemble an aspect of the event
- Marked physiological reactions to internal or external cues that resemble an aspect
of the event
- C: Persistent avoidance of stimuli associated with the event, beginning after the
event occurred, as evidenced by one or both of the following:
- Avoidance of, or efforts to, avoid distressing memories, thoughts, or feelings about,
or closely associated with traumatic events
- Avoidance of, or efforts to, avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or feelings
about or associated with the event
- D: Negative alterations in cognition and mood associated with the event, beginning,
or worsening after the event, evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event (due to
dissociative amnesia not head injuries or other reason)
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or
of the world
- Persistent, distorted cognitions about the cause or consequences of the event that
leads to self-blame, or blame on others
- Persistent negative emotional state
- Markedly diminished interest or participation in activities
- Feelings of detachment from others
- Persistent inability to experience positive emotions
, - E: Marked alterations in arousal and reactivity associated with the traumatic event,
beginning or worsening after the event occurred, evidenced by two or more of the
following:
- Irritable behaviour and angry outbursts with little to no provocation, typically
expressed as verbal or physical aggression
- Reckless or self-destructive behaviour
- Hyper-vigilance
- Exaggerated startle response
- Problems concentrating
- Sleep disturbances
- F: the duration of B, C, D, & E is more than one month
- G: the disturbance causes clinically significant distress or impairment in social,
occupational, or other important area of functioning
- H: the disturbance is not attributable to substances (meds, alcohol, drugs) or another
medical condition
ICD-10;
- A: The patient must have been exposed to a stressful event or situation of
exceptionally threatening or catastrophic nature, which would likely cause pervasive
distress in anyone
- B: There must be persistent remembering or “reliving” of the stressor in intrusive
flashbacks, vivid memories, or recurring dreams, or experiencing distress when
exposed to circumstances resembling the stressor
- C: The patient must exhibit an actual or preferred avoidance of circumstances
resembling the stressor which was not present before exposure to the stressor
- D: Either of the following must be present:
- 1) Inability to recall, either partially or completely, some important aspects of the
period of exposure
- 2) Persistent symptoms of increased psychological sensitivity and arousal not
present before the stressor, shown by any two of the following:
- Difficulty falling or staying asleep
- Irritability or outburst of anger
- Difficulty in concentrating
- Hypervigilance
- Exaggerated startle response
- E: Criteria B, C & D must all be met within 6 months of the event. For some purposes,
onset delayed more than 6 months may be included, but this should be clearly
specified.
Links to Violence & Crime
PTSD and crime;
- Predominately research focuses on war veterans
- Newer studies starting to look at general pop/forensic samples, but needs more
work done!
- Typically most studies on PTSD & crime are in terms of the victims, not the perps!
