WEEK 8: PTSD
1. DSM-5: Post Traumatic Stress Disorder (PTSD)
Diagnostic criteria
,Diagnostic features
Essential feature: development of characteristic symptoms following exposure to one or more
traumatic events.
The clinical presentation of PTSD varies:
o sometimes fear-based reexperiencing, emotional, and behavioral symptoms predominate
o in others, anhedonic or dysphoric mood states and negative cognitions are most distressing
o arousal and reactive-externalizing symptoms could be prominent
o or dissociative symptoms predominate
o sometimes, combinations of these symptom patterns are exhibited
Directly experienced traumatic events include but are not limited to:
o exposure to war as a combatant or civilian
o threatened or actual physical assault
o threatened or actual sexual violence
o being kidnapped or taken hostage
o terrorist attack, torture, incarceration as a prisoner of war
o natural or human-made disasters
o severe motor vehicle accidents
o sudden, catastrophic medical events
Witnessed events include, but are not limited to:
o observing threatened or serious injury, unnatural death, physical or sexual abuse of another
o observing domestic violence, accident, war or disaster, medical catastrophe in one's child
Indirect exposure through learning about an event is limited to: experiences affecting close
relatives or friends and experiences that are violent or accidental (violent personal assault, suicide,
serious accident, and serious injury)
The traumatic event can be reexperienced in various ways:
o commonly: recurrent, involuntary, and intrusive recollections of the event which are
distinguished from depressive rumination in that they apply only to involuntary and intrusive
distressing memories related to traumatic events
o recurrent distressing dreams related to the traumatic event
o dissociative states that last from a few seconds to several hours or even days, during which
components of the event are relived
Stimuli associated with the trauma are persistently (e.g., always or almost always) avoided:
1. deliberate efforts to avoid thoughts, memories, feelings, or talking about the traumatic event
2. deliberate efforts to avoid activities, objects, situations, or people who arouse recollections of
it
Negative alterations in cognitions or mood associated with the event begin or worsen after
exposure to the event. Many forms:
o inability to remember an important aspect of the traumatic event
o exaggerated negative expectations regarding important aspects of life applied to oneself,
others, or the future that can result in negative change in perceived identity since the trauma
o persistent negative mood state (e.g., fear, horror, anger, guilt, shame) either began or worsened
after exposure to the event
, o markedly diminished interest or participation in previously enjoyed activities
o feeling detached or estranged from other people
o persistent inability to feel positive emotions
o quick tempered; may even engage in aggressive verbal and/or physical behavior with little or
no provocation
o may engage in reckless or self-destructive behavior
o heightened sensitivity to potential threats
o concentration difficulties, including difficulty remembering daily events
o sleep disturbances
Associated features supporting diagnosis
Developmental regression (such as loss of language in children)
Auditory pseudo-hallucinations (having the sensory experience of hearing one's thoughts spoken
in one or more different voices) and paranoid ideation
Difficulties in regulating emotions or maintaining stable interpersonal relationships
Prevalence
US lifetime risk (lifetime prevalence): 8.7%
US 12-month prevalence: 3.5%
Lower estimates in Europe, and most Asian, African, and Latin American countries: 0.5 – 1%
The conditional probability of developing PTSD following a similar level of exposure to traumatic
events may also vary across cultural groups.
o compared with US non-Latino whites, higher rates are among US Latinos, African Americans,
and American Indians
o lower rates have been reported among Asian Americans
Rates are higher among:
o veterans and others whose vocation increases the risk of traumatic exposure
o survivors of rape
o survivors of military combat, captivity and ethnically or politically motivated internment and
genocide
Prevalence of PTSD may vary across development: lower prevalence among children and
adolescents, as well as older adults
Development and course
PTSD can occur at any age, beginning after the first year of life.
Symptoms usually begin within the first 3 months after the trauma (but also can be delayed
expression).
Frequently, an individual's reaction to a trauma initially meets criteria for acute stress disorder in
the immediate aftermath of the trauma (and if it lasts longer than a month, it’s PTSD).
The clinical expression of reexperiencing can vary across development:
o young children: new onset of frightening dreams without content specific to the traumatic
event; reexperiencing symptoms through play; wide range of emotional or behavioral changes;
1. DSM-5: Post Traumatic Stress Disorder (PTSD)
Diagnostic criteria
,Diagnostic features
Essential feature: development of characteristic symptoms following exposure to one or more
traumatic events.
The clinical presentation of PTSD varies:
o sometimes fear-based reexperiencing, emotional, and behavioral symptoms predominate
o in others, anhedonic or dysphoric mood states and negative cognitions are most distressing
o arousal and reactive-externalizing symptoms could be prominent
o or dissociative symptoms predominate
o sometimes, combinations of these symptom patterns are exhibited
Directly experienced traumatic events include but are not limited to:
o exposure to war as a combatant or civilian
o threatened or actual physical assault
o threatened or actual sexual violence
o being kidnapped or taken hostage
o terrorist attack, torture, incarceration as a prisoner of war
o natural or human-made disasters
o severe motor vehicle accidents
o sudden, catastrophic medical events
Witnessed events include, but are not limited to:
o observing threatened or serious injury, unnatural death, physical or sexual abuse of another
o observing domestic violence, accident, war or disaster, medical catastrophe in one's child
Indirect exposure through learning about an event is limited to: experiences affecting close
relatives or friends and experiences that are violent or accidental (violent personal assault, suicide,
serious accident, and serious injury)
The traumatic event can be reexperienced in various ways:
o commonly: recurrent, involuntary, and intrusive recollections of the event which are
distinguished from depressive rumination in that they apply only to involuntary and intrusive
distressing memories related to traumatic events
o recurrent distressing dreams related to the traumatic event
o dissociative states that last from a few seconds to several hours or even days, during which
components of the event are relived
Stimuli associated with the trauma are persistently (e.g., always or almost always) avoided:
1. deliberate efforts to avoid thoughts, memories, feelings, or talking about the traumatic event
2. deliberate efforts to avoid activities, objects, situations, or people who arouse recollections of
it
Negative alterations in cognitions or mood associated with the event begin or worsen after
exposure to the event. Many forms:
o inability to remember an important aspect of the traumatic event
o exaggerated negative expectations regarding important aspects of life applied to oneself,
others, or the future that can result in negative change in perceived identity since the trauma
o persistent negative mood state (e.g., fear, horror, anger, guilt, shame) either began or worsened
after exposure to the event
, o markedly diminished interest or participation in previously enjoyed activities
o feeling detached or estranged from other people
o persistent inability to feel positive emotions
o quick tempered; may even engage in aggressive verbal and/or physical behavior with little or
no provocation
o may engage in reckless or self-destructive behavior
o heightened sensitivity to potential threats
o concentration difficulties, including difficulty remembering daily events
o sleep disturbances
Associated features supporting diagnosis
Developmental regression (such as loss of language in children)
Auditory pseudo-hallucinations (having the sensory experience of hearing one's thoughts spoken
in one or more different voices) and paranoid ideation
Difficulties in regulating emotions or maintaining stable interpersonal relationships
Prevalence
US lifetime risk (lifetime prevalence): 8.7%
US 12-month prevalence: 3.5%
Lower estimates in Europe, and most Asian, African, and Latin American countries: 0.5 – 1%
The conditional probability of developing PTSD following a similar level of exposure to traumatic
events may also vary across cultural groups.
o compared with US non-Latino whites, higher rates are among US Latinos, African Americans,
and American Indians
o lower rates have been reported among Asian Americans
Rates are higher among:
o veterans and others whose vocation increases the risk of traumatic exposure
o survivors of rape
o survivors of military combat, captivity and ethnically or politically motivated internment and
genocide
Prevalence of PTSD may vary across development: lower prevalence among children and
adolescents, as well as older adults
Development and course
PTSD can occur at any age, beginning after the first year of life.
Symptoms usually begin within the first 3 months after the trauma (but also can be delayed
expression).
Frequently, an individual's reaction to a trauma initially meets criteria for acute stress disorder in
the immediate aftermath of the trauma (and if it lasts longer than a month, it’s PTSD).
The clinical expression of reexperiencing can vary across development:
o young children: new onset of frightening dreams without content specific to the traumatic
event; reexperiencing symptoms through play; wide range of emotional or behavioral changes;
