Post Traumatic Stress Disorder

What is PTSD? Below you will find a legal and medical diagnosis, symptoms and classification. However, we feel that most people might relate easier to this from Liza Gold, psychiatry professor at Georgetown University School of Medicine:

'We're not talking about someone who says, "I jump every time I hear a plane go by"...

We're talking about someone who says, "I jump every time I hear a plane go by, so I don't go out of my house, and as a result I've lost my job." That's Post Traumatic Stress Disorder.'

Criteria for Diagnosing Post Traumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

• The person has experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
• The person's response involved intense fear, helplessness, or horror (in children, disorganised or agitated behaviour).

B. The traumatic event is persistently re-experienced in a least one (or more) of the following ways:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions (in young children, repetitive play may occur in which themes or aspects of the trauma are expressed);
• Recurrent distressing dreams of the event (in children, there may be frightening dreams without recognisable content);
• Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated), (in young children, trauma-specific re-enactment may occur);
• Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;
• Physiologic reactivity' on exposure to internal and external cues that symbolise or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three (or more) of the following:

• Efforts to avoid thoughts, feelings or conversations associated with the trauma;
• Efforts to avoid activities, places,' or people that arouse recollections of the trauma;
• Inability to recall an important aspect of the trauma;
• Markedly diminished interest or participation in significant activities;
• Feelings of detachment or estrangement from others;
• Restricted range of affect (e.g. unable to have loving feelings);
• sense of a foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma), as Indicated by at least two (or more) of the following:

• Difficulty falling or staying asleep;
• Irritability or outbursts of anger;
• Difficulty concentrating;
• Hypervigilance;
• Exaggerated startle response

E. Duration of the disturbance (symptoms in criteria B, C and D) is more than one Month.

F. The disturbance causes clinically significant distress or marked impairment in Social occupational, or other important areas of functioning.

Classification of Mental And Behavioural Disorders

Post Traumatic Stress Disorder

This arises as a delayed and/or protracted response to a stressful event or situation (either short or long-lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (e.g. natural or manmade disaster, combat, serious accident, witnessing the violent death of others, or being the victim of torture, terrorism, rape, or other crime).

Predisposing factors such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence.

Typical symptoms include episodes of repeated reliving of the trauma in intrusive memories ('flashbacks') or dreams, occurring against the persisting background of a sense of 'numbness' and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situation reminiscent of the trauma. Commonly there is fear and avoidance of cues that remind the sufferer of the original trauma. Rarely, there may be dramatic, acute bursts of fear, panic or aggression, triggered by stimuli arousing a sudden recollection and/or re-enactment of the trauma or of the original reaction to it.

There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly association with the above symptoms and signs, and suicidal ideation is not infrequent. Excessive use of alcohol or drugs may be a complicating factor.

The onset follows the trauma with a latency period, which may range from a few weeks to months (but rarely exceeds 6 months. The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of patients the condition may show a chronic course over many years and a transition to an enduring personality change.

Diagnostic Guidelines

This disorder should not generally be diagnosed unless there is evidence that it arose within 6 months of a traumatic event of exceptional severity. A 'probable' diagnosis might still be possible if the delay between the event and the onset was longer than 6 months, provided that the clinical manifestations are typical and no alternative identification of the disorder (e.g. as an anxiety or obsessive-compulsive disorder or depressive episode) is plausible. In addition to evidence of trauma, there must be a repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery, or dreams. Conspicuous emotional detachment, numbing of feeling, and avoidance of stimuli that might arouse recollection of the trauma are often present but are not essential for the diagnosis. The autonomic disturbances, mood disorder, and behavioural abnormalities all contribute to the diagnosis but are not of prime importance.