Diagnostic Criteria for Posttraumatic Stress Disorder

[David Baxter PhD]

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

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

(1) the person 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
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) 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 on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize 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 three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) 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 two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

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

Specify if:

Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

 

[texasgirl]

Re: Diagnostic criteria for Posttraumatic Stress Disorder

David, I have a fundamental question about whether or not the body can ever get over repeated trauma in childhood, especially years of torture and sexual abuse and what therapy can do to heal it. I guess I don't really understand how it works.

 

[David Baxter PhD]

Re: Diagnostic criteria for Posttraumatic Stress Disorder

I think terms like "get over", "cure", etc., are difficult to apply to many injuries or conditions, whether they are physical or psychological.

I'll use the example of grief: Does one ever "get over" the loss of a loved one? You can learn to better accept the loss. You can learn to cope with it. You can learn to focus on all the positive things the person contributed during his/her life. You can learn to focus and take comfort in the legacy of that person's life. But it's unlikely you will ever stop missing the person.

With traumatic experiences of any kind, especially repeated traumatic experiences, I doubt that you will ever get to the point where you just dismiss and forget them. But you can certainly get to a point where the damage they continue to do is negated or minimized, and where you have control over PTSD symptoms. That is really the objective of therapy for many conditions or disorders.

 

[texasgirl]

Re: Diagnostic criteria for Posttraumatic Stress Disorder

The grief analogy is really a helpful one. When my husband committed suicide I thought that I would never get over it. Now I can talk about it without having the initial acute pain that I felt when he died. I guess that that is what I should try for in going to therapy for the first time. It is just that there are so many things that happened that it feels so overwheming and like it's still happening a lot of the time. I do believe, however, that talking about it, as excrutiating as it can be sometimes, at least gets it outside of my head and in the air, if nowhere else. Then it's almost like what happened is objectified instead of inside of me. It becomes real and someone else KNOWS instead of it being hidden in me like some kind of terrible secret. Maybe then I can learn to cope with it, like I did when my husband died. Thank you for your help. It really does help.