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POSTTRAUMATIC STRESS DISORDER

ESSENTIALS OF DIAGNOSIS

The diagnosis of posttraumatic stress disorder (PTSD) requires that patients screen positive for experiences/symptoms in each of eight categories (Criteria A–H). The patient must meet at least one (or more) of the specified criteria in each category (Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5], 2013). For example:

Criterion A (one is required): The patient must have or have had “exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

  • Directly experiencing the traumatic event.

  • Witnessing, in person, the event(s) as it occurred to others.

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

  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responder collecting human remains, police officers repeatedly exposed to details of child abuse).”

General Considerations

In the most recent edition of the DSM-5 (2013), posttraumatic stress disorder (PTSD) is classified as a trauma- and stressor-related disorder, not as a disorder consisting 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. 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, 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. An important revision in DSM-5 is the removal of the requirement that the individual’s reaction must include extreme fear or horror. This criterion was not empirically supported and was not found to increase diagnostic accuracy.

While this condition has likely existed since human beings have endured trauma, PTSD entered the medical diagnostic realm with the publication of the DSM-3 in 1980. It was first brought to public attention in relation to war veterans and, depending on the time frame of the war, has been known by a number of different terms, including combat fatigue, gross stress reaction, post-Vietnam syndrome, shell shock, and battle fatigue. Currently, PTSD is described as a disorder of persistent reactivity in many 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 are the cornerstone of chronic PTSD.

Combat-related PTSD is the result of traumatic experiences occurring in the context ...

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