In PTSD, the uniting factor is a lingering memory of feelings, thoughts, or images that remain present for some time following an extreme event. These stored sensations may be re-experienced along with a replay of any physiological reactions felt or experienced during the time of the original event (i.e. racing heart, rapid breathing, feelings of falling, or sensations of being trapped, etc.).
Diagnosis of PTSD is based on criteria from theDiagnostic and Statistical Manual of Mental Disorders(5th edition)7
Diagnosis of PTSD may only occur when all of the following criteria are present or addressed. Once met, one of two specifications may (or may not) be added to the core diagnosis of PTSD:
Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):
- Intrusive thoughts
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related reminders
Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
|Criterion F (required): Symptoms last for more than one month.|
|Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).|
|Criterion H (required): Symptoms are not due to medication, substance use, or other illness. |
Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization. The experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or as one were in a dream).
- Derealization. The experience of unreality, distance, or distortion (e.g., "things are not real").
|Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.|
Children are not exempt from lingering effects of trauma. Younger children, in particular, may have different reactions to trauma than adults. For children aged five years or younger, typical reactions can include a fear of being separated from a parent or caretaker, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions, and excessive clinging. Parents may also notice regressive behaviors. Children of this age tend to be strongly affected by their parents' reactions to the traumatic event.
Children aged six through eleven years may show extreme withdrawal, disruptive behavior, and/or an inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger, and fighting are also common. The child may have somatic complaints with no medical basis. Schoolwork often suffers. Also, depression, anxiety, feelings of guilt, and emotional numbing are frequently present.
Adolescents aged twelve through seventeen years may have responses similar to adults.
No matter what the age, those who experience the effects of PTSD report a continual reliving of the trauma. This reliving can occur in the form of nightmares and/or disturbing recollections, sensations, or emotions that occur during the day. Sleep problems, depression, feelings of numbness or detachment are common. Sufferers may lose interest in things that they once enjoyed, including experiencing affection. Irritability, an increase in aggressiveness, and even violence can be new behaviors that they did not exhibit before.
Many with PTSD report experiencing distress when seeing events, objects, or persons which remind them of the traumatic event. It is common to avoid key places, situations, or people who provoke recall of events they would like to forget. Dates, such as the anniversary of the triggering event, can be especially difficult.
Ordinary, commonplace events can serve as memory association triggers for intrusive images or flashbacks. Typically, a flashback is a disassociation from reality with a reenactment or intensely real memory of the traumatic event. An individual reliving a flashback can experience sounds, smells, images, and even feelings from the original event, and often believes that the event is occurring all over again. Flashbacks may last seconds or hours. Rarely, a flashback may last for days.