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  • Directly experiences the traumatic event.

  • Witnesses the traumatic event in person.

  • Learns that the traumatic event occurred to a close family member or close friend (where the actual or threatened death was violent or accidental)

  • Experiences firsthand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television, or movies unless work-related)

General Considerations

In the newly released DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), posttraumatic stress disorder (PTSD) is classified as a trauma and stressor-related disorder, not a disorder primarily of anxiety alone. The criterion for the diagnosis conceptualizes trauma as the precipitating event where the person experiences, witnesses, or is confronted with an event or events that threaten death or serious injury or posed a threat to the physical integrity of self or others, and the person’s response must have involved fear, helplessness, or horror. The events are beyond the realm of usual and normal human experience and include traumatic events such as war or the Holocaust; natural disasters such as earthquakes and tsunamis, ­hurricanes, and volcanic eruptions; and anthropogenic disasters, including factory explosions, automobile crashes, and airplane crashes. Critical to understanding the diagnosis is the idea that the cause of the illness was a traumatic event that occurred outside of the individual and was not due to an inherent character or personality weakness of that person.

While this condition has likely existed since human beings have endured trauma, PTSD entered the medical diagnostic realm with the publication of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) in 1980. It was first brought to public attention in relation to war veterans and, depending on the name of the war, has been known by a number of different terms to include combat fatigue, gross stress reaction, post-Vietnam syndrome, shell shock, and battle fatigue. Currently, PTSD is described as a disorder of persistent reactivity in all areas of self-regulation, not just troubling memories and chronic anxiety. Distressing memories of past traumatic events and intense stress reactions to reminders of those events that occur in the person’s current life continue to serve as the cornerstone of PTSD.

Essentially, the brain is a control system that regulates the body functions. Trauma forces the brain to make profound biological adaptations in how it operates. When the body is safe and working well, the brain extends its efforts to the “higher” functions that enable you to not only survive but also become a conscious individual. However, when the brain detects serious threats to body survival, traumatic stressors such as severe accidents, disasters, violence, abuse, or betrayals, the alarm system in the brain is activated and takes control of the rest of the brain’s operations, putting all systems in emergency mode until the threat is overcome. In most cases, with nontraumatic ...

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