Post-Traumatic Stress Disorder has likely been around since humans first had to cope with traumatic events. A bad run-in with a saber-tooth tiger could certainly have triggered a traumatic response in our earliest ancestors. However, it became officially recognized as a disorder within the American Psychiatric Association’s Diagnostic manual (referred to as the DSM, with the DSM-5 being the most recent edition) in 1980. Since that time research has led to revisions in the criteria used for diagnosis. A mental health professional is best equipped to make a formal diagnosis of PTSD, but reviewing the following diagnostic criteria may help you better understand what types of situations can produce PTSD and its symptoms. My additional comments are shown in italics within the criteria list. For PTSD to be diagnosed the following must be present:
A. STRESSOR. Exposure to actual or threatened death, actual or threatened serious injury, or actual or threatened sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s).
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. In cases of actual or threatened death of family member or friend, the event(s) must have been violent or due to an accident.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
It is important to note that the trauma has to involve an exposure to actual or threatened death, serious injury or sexual violence. To be considered a trauma in regard to PTSD, the event(s) have to fall into these categories. Having an emotionally abusive relationship, for example, can feel potentially traumatic but would probably not meet criteria for PTSD. Additionally, the criteria requires that in cases where one learns of a trauma of actual or threatened death that the event must have been violent or accidental; this is as opposed to, for example, a health crisis (heart attack, stroke) that leads to death or risk of death.
B. INTRUSION SYMPTOMS. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the trauma(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). This refers to unwelcome and upsetting thoughts and memories that come into your mind outside of your control. You don’t want these memories but they seem to pop in on their own.
Traumatic nightmares in which the content and/or effect of the dream are related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme being a complete loss of awareness of present surroundings.) Flashbacks are different than memories. As described, a flashback feels like you are re-experiencing the event. Sometimes people describe this experience as feeling like they are in a video or watching a video of the actual event that is playing in real time. During a flashback it may be hard to communicate with the person and loved ones may describe the person as seeming to be “somewhere else” in their mind.
Intense or prolonged distress after exposure to reminders of the trauma. These “reminders” are often referred to as “triggers.”
Marked physiologic reaction after exposure to trauma-related stimuli. This might include your heart beating fast or breaking into a sweat. Such stimuli might also be considered “triggers.”
C. AVOIDANCE SYMPTOMS. Persistent effortful avoidance of distressing stimuli associated with the traumatic event(s), beginning after the trauma(s) occurred, as evidenced by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). This symptom helps explain why people with PTSD often isolate themselves at home and avoid crowds (which can be seen as dangerous and unpredictable).
D. NEGATIVE ALTERATIONS IN THOUGHTS AND MOOD. Negative changes in thoughts and mood associated with the traumatic event(s), beginning or worsening after the trauma(s) occurred, as evidenced by two or more of the following:
Inability to remember an important part of the trauma(s) (usually due to dissociative amnesia and NOT due to other factors such as head injury, alcohol, or drugs).
Persistent and often distorted negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is always dangerous”).
Persistent, distorted blame of self or others for causing the trauma (s) or for resulting consequences.
Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in activities engaged in pre-trauma.
Feelings of detachment or estrangement from others. Sometimes people describe this as feeling numb.
Persistent inability to have positive emotions such as happiness, satisfaction, or loving feelings.
E. ALTERATIONS IN AROUSAL AND REACTIVITY. Trauma-related alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following:
Irritable or aggressive behavior.
Reckless or self-destructive behavior.
Hypervigilance. This is often described by patients as feeling like they can’t let their guard down at any time. They are constantly on the lookout for danger.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (difficulty falling or staying asleep or restless sleep).
F. DURATION. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. FUNCTIONAL SIGNIFICANCE. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. UNRELATED TO SUBSTANCE USE. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
If you’d like to discuss these symptoms further or learn more about PTSD treatments, please call me, Dr. Jana Drew, at 512-960-5265 or contact me here.