Posttraumatic Stress Disorder - Symptoms

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What are PTSD symptoms and signs?

The following three groups of symptom criteria are required to assign the diagnosis of PTSD in the context of an individual who has a history of being exposed to an actual or perceived threat of death, serious injury, or sexual violence to self or others that does not involve exposure through media unless that is work related:

  • Recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by reminders of the traumatic events, recurring nightmares about the trauma and/or dissociative reliving of the trauma): In children, this may include repetitive play about the trauma.
  • Avoidance to the point of having a phobia of places, people, and experiences that remind the sufferer of the trauma, or a general numbing of emotional responsiveness
  • Negative changes in thinking and trouble remembering important aspects of the trauma, holding negative beliefs about him or herself, a tendency to blame oneself for the trauma, a persistently negative emotional state, inability to have positive emotions, low interest or participation in significant activities, and feeling detached from others
  • Significant changes in arousal and reactivity related to the traumatic event(s), including sleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, reckless or self-destructive behavior, increased tendency and reaction to being startled, and hypervigilance (excessive watchfulness) to threat

The emotional numbing of PTSD may present as a lack of interest in activities that used to be enjoyed (anhedonia), emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future (for example, not being able to think about the future or make future plans, not believing one will live much longer). At least one re-experiencing symptom, one avoidance symptom, two negative changes in mood or thinking, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or impairment in functioning in order for the diagnosis of PTSD to be assigned.

A similar disorder in terms of symptom repertoire is acute stress disorder. The major differences between the two disorders are that acute stress disorder symptoms persist from three days to one month after the trauma exposure, and a fewer number of traumatic symptoms are required to make the diagnosis as compared to PTSD.

In children, re-experiencing the trauma may occur through repeated play that has trauma-related themes instead of or in addition to memories, and distressing dreams may have more general content rather than of the traumatic event itself. As in adults, at least one re-experiencing symptom, one avoidance/numbing symptom, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. When symptoms have been present for three days to one month, a diagnosis of acute stress disorder (ASD) can be made.

Symptoms of PTSD that tend to be associated with C-PTSD include problems regulating feelings, which can result in suicidal thoughts, explosive anger, or passive aggressive behaviors, a tendency to forget the trauma or feel detached from one's life (dissociation) or body (depersonalization), persistent feelings of helplessness, shame, guilt, or being completely different from others, feeling the perpetrator of trauma is all powerful, and preoccupation with either revenge against or allegiance with the perpetrator, and severe change in those things that give the sufferer meaning, like a loss of spiritual faith or an ongoing sense of helplessness, hopelessness, or despair.

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