Term
| Posttraumatic Stress Disorder codes |
|
Definition
|
|
Term
The following criteria apply to adults, For children 6 years and
younger, the criteria symptoms may be different, including |
|
Definition
| , there may be frightening dreams without recognizable content and trauma specific reenactment may occur in play. |
|
|
Term
| criterion A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: |
|
Definition
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or
threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. 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).
1. Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless
this exposure is work related. |
|
|
Term
criterion B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after
the traumatic event(s) occurred: |
|
Definition
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
1. Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic
event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic
event(s).
1. Note: In children, there may be frightening dreams without recognizable content.
3. 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 expression being a complete loss of
awareness of present surroundings.)
1. Note: In children, traumaspecific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble
an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic
event(s). |
|
|
Term
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s)
occurred, as evidenced by one or both of the following: |
|
Definition
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the
traumatic event(s).
2. 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). |
|
|
Term
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more) of the following: |
|
Definition
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not
to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,”
“No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently
ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual
to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving
feelings). |
|
|
Term
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more) of the following: |
|
Definition
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical
aggression toward people or objects.
2. Reckless or selfdestructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep) |
|
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Term
| F. Duration of the disturbance (Criteria B, C, D, and E) |
|
Definition
|
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Term
| G. The disturbance causes clinically significant distress or impairment in |
|
Definition
social, occupational, or other important areas of
functioning. |
|
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Term
| H. The disturbance is not attributable to the physiological effects of |
|
Definition
a substance (e.g., medication, alcohol) or another
medical condition. |
|
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Term
|
Definition
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in
addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the
following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside
observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of
unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the
individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a
substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex
partial seizures). |
|
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Term
Specify if:
With delayed expression: |
|
Definition
If the full diagnostic criteria are not met until at least 6 months after the event (although
the onset and expression of some symptoms may be immediate). |
|
|
Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in one (or
more) of the following ways: |
|
Definition
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others, especially primary caregivers.
1. Note: Witnessing does not include events that are witnessed only in electronic media, television, movies, or
pictures.
3. Learning that the traumatic event(s) occurred to a parent or caregiving figure. |
|
|
Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after
the traumatic event(s) occurred: |
|
Definition
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
1. Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as
play reenactment.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic
event(s).
1. Note: It may not be possible to ascertain that the frightening content is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring.
(Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness
of present surroundings.) Such traumaspecific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble
an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the traumatic event(s). |
|
|
Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the
traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be
present, beginning after the event(s) or worsening after the event(s): |
|
Definition
Persistent Avoidance of Stimuli
1. Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic
event(s).
2. Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the
traumatic event(s).
1. Negative Alterations in Cognitions9/9/13
10/28
3. Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
4. Markedly diminished interest or participation in significant activities, including constriction of play.
5. Socially withdrawn behavior.
6. Persistent reduction in expression of positive emotions. |
|
|
Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more) of the following: |
|
Definition
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical
aggression toward people or objects (including extreme temper tantrums).
2. Hypervigilance.
3. Exaggerated startle response.
4. Problems with concentration.
5. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). |
|
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Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
E. The duration of the disturbance is |
|
Definition
|
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Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
F. The disturbance causes clinically significant distress or impairment in relationships with |
|
Definition
parents, siblings, peers, or
other caregivers or with school behavior. |
|
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Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
G. The disturbance is not attributable to the physiological effects of a |
|
Definition
substance (e.g., medication or alcohol) or another
medical condition. |
|
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Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and
the individual experiences persistent or recurrent symptoms of either of the following: |
|
Definition
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside
observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of
unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the
individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the phys |
|
|
Term
Posttraumatic Stress Disorder for Children 6 Years and Younger
Specify ifSpecify if:
With delayed expression: |
|
Definition
If the full diagnostic criteria are not met until at least 6 months after the event (although
the onset and expression of some symptoms may be immediate). |
|
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Term
Diagnostic Features
The essential feature of posttraumatic stress disorder (PTSD) is the development of |
|
Definition
characteristic symptoms following
exposure to one or more traumatic events. |
|
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Term
Diagnostic Features
Emotional reactions to the traumatic event (e.g., fear, helplessness, horror) |
|
Definition
are
no longer a part of Criterion A. |
|
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Term
Diagnostic Features
The clinical presentation of PTSD varies. In some individuals, |
|
Definition
fearbased reexperiencing,
emotional, and behavioral symptoms may predominate. In others, anhedonic or dysphoric mood states and negative
cognitions may be most distressing. In some other individuals, arousal and reactiveexternalizing symptoms are prominent,
while in others, dissociative symptoms predominate. Finally, some individuals exhibit combinations of these symptom
patterns. |
|
|
Term
The directly experienced traumatic events in Criterion A include, but are not limited to, exposure to war as a combatant or
civilian, threatened or actual |
|
Definition
physical assault (e.g., physical attack, robbery, mugging, childhood physical abuse), threatened
or actual sexual violence (e.g., forced sexual penetration, alcohol/drugfacilitated sexual penetration, abusive sexual contact,
noncontact sexual abuse, sexual trafficking) (Basile et al. 2013), being kidnapped, being taken hostage, terrorist attack,
torture, incarceration as a prisoner of war, natural or humanmade disasters, and severe motor vehicle accidents. |
|
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Term
For
children, sexually violent events may include |
|
Definition
developmentally inappropriate sexual experiences without physical violence or
injury. |
|
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Term
| A lifethreatening illness or debilitating medical condition is |
|
Definition
| not necessarily considered a traumatic event. |
|
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Term
Medical9/9/13
11/28
incidents that qualify as traumatic events involve |
|
Definition
sudden, catastrophic events (e.g., waking during surgery, anaphylactic
shock). |
|
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Term
| Witnessed events include, but are not limited to, observing |
|
Definition
threatened or serious injury, unnatural death, physical or
sexual abuse of another person due to violent assault, domestic violence, accident, war or disaster, or a medical catastrophe
in one’s child (e.g., a life
threatening hemorrhage). |
|
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Term
Indirect exposure through learning about an event is limited to
experiences affecting |
|
Definition
close relatives or friends and experiences that are violent or accidental (e.g., death due to natural
causes does not qualify). Such events include violent personal assault, suicide, serious accident, and serious injury. The
disorder may be especially severe or longlasting when the stressor is interpersonal and intentional (e.g., torture, sexual
violence). |
|
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Term
| The traumatic event can be reexperienced in various ways. Commonly, the individual has |
|
Definition
recurrent, involuntary, and
intrusive recollections of the event (Criterion B1). Intrusive recollections in PTSD are distinguished from depressive
rumination in that they apply only to involuntary and intrusive distressing memories. The emphasis is on recurrent memories
of the event that usually include sensory, emotional, or physiological behavioral components. |
|
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Term
A common reexperiencing
symptom is |
|
Definition
distressing dreams that replay the event itself or that are representative or thematically related to the major
threats involved in the traumatic event (Criterion B2). |
|
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Term
| The individual may experience dissociative states that last |
|
Definition
from a few
seconds to several hours or even days, during which components of the event are relived and the individual behaves as if
the event were occurring at that moment (Criterion B3). |
|
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Term
| Such events occur on a continuum from |
|
Definition
brief visual or other sensory
intrusions about part of the traumatic event without loss of reality orientation, to complete loss of awareness of present
surroundings |
|
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Term
| These episodes, often referred to as |
|
Definition
“flashbacks,” are typically brief but can be associated with prolonged
distress and heightened arousal. |
|
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Term
| For young children, reenactment of events related to trauma may appear in |
|
Definition
play or in
dissociative states. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when
the individual is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., windy days
after a hurricane; seeing someone who resembles one’s perpetrator). |
|
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Term
| The triggering cue could be a physical |
|
Definition
sensation (e.g.,
dizziness for survivors of head trauma; rapid heartbeat for a previously traumatized child), particularly for individuals with
highly somatic presentations (Friedman et al. 2011). |
|
|
Term
Stimuli associated with the trauma are persistently (e.g., always or almost always) avoided.
The individual commonly makes
deliberate efforts to avoid thoughts, memories, feelings, or talking about the traumatic event (e.g., utilizing distraction
techniques to avoid internal reminders) (Criterion C1) |
|
Definition
avoided. The individual commonly makes
deliberate efforts to avoid thoughts, memories, feelings, or talking about the traumatic event (e.g., utilizing distraction
techniques to avoid internal reminders) (Criterion C1)
and to avoid activities, objects, situations, or people who arouse
recollections of it (Criterion C2). |
|
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Term
| Negative alterations in cognitions or mood associated with the event begin or worsen |
|
Definition
| after exposure to the event |
|
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Term
| negative alterations can take various forms, including an |
|
Definition
inability to remember an important aspect of the traumatic event;
such amnesia is typically due to dissociative amnesia and is not due to head injury, alcohol, or drugs (Criterion D1). |
|
|
Term
Another
form is persistent (i.e., always or almost always) and exaggerated negative |
|
Definition
expectations regarding important aspects of life
applied to oneself, others, or the future (e.g., “I have always had bad judgment”; “People in authority can’t be trusted”) that
may manifest as a negative change in perceived identity since the trauma (e.g., “I can’t trust anyone ever again”; Criterion
D2) |
|
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Term
| Individuals with PTSD may have persistent erroneous |
|
Definition
cognitions about the causes of the traumatic event that lead them
to blame themselves or others (e.g., “It’s all my fault that my uncle abused me”) (Criterion D3). |
|
|
Term
. A persistent negative mood
state (e.g., fear, horror, anger, guilt, shame) either began or worsened |
|
Definition
| after exposure to the event (Criterion D4). |
|
|
Term
. These
negative alterations can take various forms, including an inability to remember an important aspect of the traumatic event;
such amnesia is typically due to dissociative amnesia and is not due to head injury, alcohol, or drugs (Criterion D1) |
|
Definition
| to head injury, alcohol, or drugs (Criterion D1) |
|
|
Term
Another
form is persistent (i.e., always or almost always) |
|
Definition
and exaggerated negative expectations regarding important aspects of life
applied to oneself, others, or the future (e.g., “I have always had bad judgment”; “People in authority can’t be trusted”) that
may manifest as a negative change in perceived identity since the trauma (e.g., “I can’t trust anyone ever again”; Criterion
D2) |
|
|
Term
| Individuals with PTSD may have persistent erroneous |
|
Definition
cognitions about the causes of the traumatic event that lead them
to blame themselves or others (e.g., “It’s all my fault that my uncle abused me”) (Criterion D3). |
|
|
Term
A persistent negative mood
state |
|
Definition
(e.g., fear, horror, anger, guilt, shame) either began or worsened after exposure to the event (Criterion D4). The
individual may experience markedly diminished interest or participation in previously enjoyed activities (Criterion D5) feeling
detached or estranged from other people (Criterion D6), or a persistent inability to feel positive emotions (especially
happiness, joy, satisfaction, or emotions associated with intimacy, tenderness, and sexuality) (Criterion D7) |
|
|
Term
Individuals with PTSD may be quick tempered and may even engage in aggressive verbal and/or physical behavior with little
or no provocation (e.g., yelling at people, getting into fights, destroying objects) (Criterion E1). |
|
Definition
aggressive verbal and/or physical behavior with little
or no provocation (e.g., yelling at people, getting into fights, destroying objects) (Criterion E1). |
|
|
Term
They may also engage in
reckless or selfdestructive behavior such as dangerous driving, excessive alcohol or drug use, or selfinjurious or suicidal
behavior (Criterion E2). PTSD is often characterized by a heightened sensitivity to potential threats, including those that are
related to the traumatic experience (e.g., following a motor vehicle accident, being especially sensitive to the threat
potentially caused by cars or trucks) and those not related to the traumatic event (e.g., being fearful of suffering a heart
attack) (Criterion E3) |
|
Definition
dangerous driving, excessive alcohol or drug use, or selfinjurious or suicidal
behavior (Criterion E2). PTSD is often characterized by a heightened sensitivity to potential threats, including those that are
related to the traumatic experience (e.g., following a motor vehicle accident, being especially sensitive to the threat
potentially caused by cars or trucks) and those not related to the traumatic event (e.g., being fearful of suffering a heart
attack) (Criterion E3) |
|
|
Term
Individuals with PTSD may be very reactive to
unexpected stimuli, |
|
Definition
displaying a heightened startle response, or jumpiness, to loud noises or unexpected movements (e.g.,
jumping markedly in response to a telephone ringing) (Criterion E4). Concentration difficulties, including difficulty
remembering daily events (e.g., forgetting one’s telephone number) or attending to focused tasks (e.g., following a
conversation for a sustained period of time), are commonly reported (Criterion E5). |
|
|
Term
Problems with sleep onset and
maintenance are common and may be associated with |
|
Definition
nightmares and safety concerns or with generalized elevated arousal
that interferes with adequate sleep (Criterion E6). |
|
|
Term
| Some individuals also experience persistent |
|
Definition
dissociative symptoms of
detachment from their bodies (depersonalization) or the world around them (derealization); this is reflected in the “with
dissociative symptoms” specifier |
|
|
Term
| Developmental regression, |
|
Definition
| such as loss of language in young children, may occur. |
|
|
Term
Auditory pseudohallucinations, such as
having the sensory experience of |
|
Definition
| hearing one’s thoughts spoken in one or more different voices |
|
|
Term
Following prolonged, repeated, and severe traumatic events (e.g., childhood
abuse, torture), |
|
Definition
the individual may additionally experience difficulties in regulating emotions or maintaining stable
interpersonal relationships, or dissociative symptoms. |
|
|
Term
Associated Features Supporting Diagnosis
Developmental regression, such as loss of language in young children, may occur. Auditory pseudohallucinations, such as |
|
Definition
having the sensory experience of hearing one’s thoughts spoken in one or more different voices (Brewin and Patel 2010), as
well as paranoid ideation, can be present. Following prolonged, repeated, and severe traumatic events (e.g., childhood
abuse, torture), the individual may additionally experience difficulties in regulating emotions or maintaining stable
interpersonal relationships, or dissociative symptoms. When the traumatic event produces violent death, symptoms of both
problematic bereavement and PTSD may be present. |
|
|
Term
Prevalence
In the United States, projected lifetime risk for PTSD using DSMIV criteria at age 75 years is |
|
Definition
8.7% (Kessler et al. 2005a).
Twelvemonth prevalence among U.S. adults is about 3.5% (Kessler et al. 2005b). Lower estimates are seen in Europe and
most Asian, African, and Latin American countries, clustering around 0.5%–1.0% |
|
|
Term
Prevalence
Lower estimates are seen in Europe and
most Asian, African, and Latin American countries, clustering around 0.5%–1.0% |
|
Definition
|
|
Term
| Rates of PTSD are higher among veterans and others whose |
|
Definition
vocation increases the risk of traumatic exposure (e.g.,
police, firefighters, emergency medical personnel). Highest rates (ranging from onethird to more than onehalf of those
exposed) are found among survivors of rape, military combat and captivity, and ethnically or politically motivated internment
and genocide. |
|
|
Term
The prevalence of PTSD may vary across development; children and adolescents, including preschool children,
generally have |
|
Definition
displayed lower prevalence following exposure to serious traumatic events; however, this may be because
previous criteria were insufficiently developmentally informed (Scheeringa et al. 2011) |
|
|
Term
The prevalence of fullthreshold PTSD
also appears to be lower among older adults compared with the general population; there is evidence that subthreshold
presentations are more common than full PTSD in later life and that these symptoms are associated with |
|
Definition
substantial clinical
impairment (Thorp et al. 2011) |
|
|
Term
| Compared with U.S. nonLatino whites, higher rates of PTSD have been reported among U.S. |
|
Definition
Latinos, African Americans, and American Indians, and lower rates have been reported among Asian Americans, after
adjustment for traumatic exposure and demographic variables |
|
|
Term
Development and Course
PTSD can occur at any age, beginning after the first year of life. Symptoms usually begin within the first 3 months after the
trauma, although there may be a delay of months, or even years, before criteria for the diagnosis are met. There is
abundant evidence for what DSMIV called “delayed onset” but is now called |
|
Definition
“delayed expression,” with the recognition that
some symptoms typically appear immediately and that the delay is in meeting full criteria |
|
|
Term
Frequently, an individual’s reaction to a trauma initially meets criteria for acute stress disorder in the immediate aftermath of
the trauma. The symptoms |
|
Definition
of PTSD and the relative predominance of different symptoms may vary over time. Duration of
the symptoms also varies, with complete recovery within 3 months occurring in approximately onehalf of adults, while some
individuals remain symptomatic for longer than 12 months (Bryant et al. 2011) and sometimes for more than 50 years. |
|
|
Term
|
Definition
declining health, worsening cognitive functioning, and social
isolation may exacerbate PTSD symptoms |
|
|
Term
| The clinical expression of reexperiencing can vary across development. Young children may report |
|
Definition
new onset of frightening
dreams without content specific to the traumatic event. Before age 6 years (see criteria for preschool subtype), young
children are more likely to express reexperiencing symptoms through play that refers directly or symbolically to the trauma.
They may not manifest fearful reactions at the time of the exposure or during reexperiencing. |
|
|
Term
Parents may report a wide
range of emotional or behavioral changes in young children. Children may focus |
|
Definition
on imagined interventions in their play or
storytelling. In addition to avoidance, children may become preoccupied with reminders. |
|
|
Term
Because of young children’s
limitations in expressing thoughts or labeling emotions, |
|
Definition
negative alterations in mood or cognition tend to involve primarily
mood changes. |
|
|
Term
| Children may experience cooccurring traumas |
|
Definition
(e.g., physical abuse, witnessing domestic violence) and in
chronic circumstances may not be able to identify onset of symptomatology |
|
|
Term
| Avoidant behavior may be associated with |
|
Definition
restricted play or exploratory behavior in young children; reduced participation in
new activities in schoolage children; or reluctance to pursue developmental opportunities in adolescents (e.g., dating,
driving) |
|
|
Term
| Older children and adolescents may judge themselves as |
|
Definition
cowardly. Adolescents may harbor beliefs of being
changed in ways that make them socially undesirable and estrange them from peers (e.g., “Now I’ll never fit in”) and lose
aspirations for the future. |
|
|
Term
| Irritable or aggressive behavior in children and adolescents can interfere with |
|
Definition
peer relationships
and school behavior. |
|
|
Term
| Reckless behavior may lead to |
|
Definition
accidental injury to self or others, thrillseeking, or highrisk behaviors9/9/13
13/28
(Pynoos et al. 2009). |
|
|
Term
| Individuals who continue to experience PTSD into older adulthood may express |
|
Definition
fewer symptoms of
hyperarousal, avoidance, and negative cognitions and mood compared with younger adults with PTSD, although adults
exposed to traumatic events during later life may display more avoidance, hyperarousal, sleep problems, and crying spells
than do younger adults exposed to the same traumatic events (Thorp et al. 2011). I |
|
|
Term
In older individuals, the disorder is
associated with |
|
Definition
| negative health perceptions, primary care utilization, and suicidal ideation (Rauch et al. 2006). |
|
|
Term
Risk and Prognostic Factors
Risk (and protective) factors are |
|
Definition
| generally divided into pretraumatic, peritraumatic, and posttraumatic factors. |
|
|
Term
Risk and Prognostic Factors
Pretraumatic factors
Temperamental |
|
Definition
These include childhood emotional problems by age 6 years (e.g., prior traumatic exposure, externalizing or anxiety
problems) and prior mental disorders (e.g., panic disorder, depressive disorder, PTSD, or obsessivecompulsive disorder
[OCD]). |
|
|
Term
Risk and Prognostic Factors
Environmental
These include |
|
Definition
lower socioeconomic status; lower education; exposure to prior trauma (especially during childhood) (Binder et
al. 2008; Cougle et al. 2009; Smith et al. 2008); childhood adversity (e.g., economic deprivation, family dysfunction, parental
separation or death); cultural characteristics (e.g., fatalistic or selfblaming coping strategies); lower intelligence; minority
racial/ethnic status; and a family psychiatric history. Social support prior to event exposure is protective. |
|
|
Term
Risk and Prognostic Factors
Genetic and physiological
These include female gender and younger age at the time of trauma exposure |
|
Definition
(for adults). Certain genotypes may either be
protective or increase risk of PTSD after exposure to traumatic events. |
|
|
Term
Peritraumatic factors
Environmental
These include |
|
Definition
severity (dose) of the trauma (the greater the magnitude of trauma, the greater the likelihood of PTSD),
perceived life threat, personal injury, interpersonal violence (particularly trauma perpetrated by a caregiver or involving a
witnessed threat to a caregiver in children) (Scheeringa et al. 2006), and, for military personnel, being a perpetrator,
witnessing atrocities, or killing the enemy. Finally, dissociation that occurs during the trauma and persists afterward is a risk
factor. |
|
|
Term
Posttraumatic factors
Temperamental
These include |
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Definition
| negative appraisals, inappropriate coping strategies, and development of acute stress disorder. |
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Term
Environmental
These include subsequent exposure to |
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Definition
repeated upsetting reminders, subsequent adverse life events, and financial or other
traumarelated losses. Social support (including family stability, for children) is a protective factor that moderates outcome
after trauma (Breslau 2009; Vogt et al. 2007). |
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Term
The
clinical expression of the symptoms or symptom clusters of PTSD may vary |
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Definition
culturally, particularly with respect to avoidance
and numbing symptoms, distressing dreams, and somatic symptoms (e.g., dizziness, shortness of breath, heat sensations). |
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Term
GenderRelated Diagnostic Issues
PTSD is more |
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Definition
prevalent among females than among males across the lifespan. Females in the general population experience
PTSD for a longer duration than do males (Kessler et al. 2005b). |
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Term
At least some of the increased risk for PTSD in females
appears to be attributable to a greater likelihood of |
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Definition
exposure to traumatic events, such as rape, and other forms of
interpersonal violence (Kessler et al. 1995). |
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Term
Suicide Risk
Traumatic events such as childhood abuse increase a person’s |
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Definition
suicide risk (Affi et al. 2008). PTSD is associated with suicidal
ideation and suicide attempts (Sareen et al. 2005; Sareen et al. 2007), and presence of the disorder may indicate which
individuals with ideation eventually make a suicide plan or actually attempt suicide (Nock et al. 2010). |
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Term
Functional Consequences of Posttraumatic Stress Disorder
PTSD is associated with |
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Definition
high levels of social, occupational, and physical disability, as well as considerable economic costs and
high levels of medical utilization (Arnow et al. 2000; Kartha et al. 2008; Kessler et al. 2005a) |
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Term
Impaired functioning is
exhibited across |
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Definition
| social, interpersonal, developmental, educational, physical health, and occupational domains. |
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Term
In community
and veteran samples, PTSD is associated with |
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Definition
poor social and family relationships, absenteeism from work, lower income,
and lower educational and occupational success (Olatunji et al. 2007; Sayer et al. 2011; Schnurr et al. 2009). |
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Term
Differential Diagnosis
Adjustment disorders
In adjustment disorders, the stressor can be of |
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Definition
any severity or type rather than that required by PTSD Criterion A. The
diagnosis of an adjustment disorder is used when the response to a stressor that meets PTSD Criterion A does not meet all
other PTSD criteria (or criteria for another mental disorder). |
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Term
An adjustment disorder is also diagnosed when the symptom
pattern of PTSD |
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Definition
occurs in response to a stressor that does not meet PTSD Criterion A (e.g., spouse leaving, being fired)
(Strain and Friedman 2011). |
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Term
| Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily |
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Definition
be attributed to PTSD.
The diagnosis requires that trauma exposure precede the onset or exacerbation of pertinent symptoms. Moreover, if the
symptom response pattern to the extreme stressor meets criteria for another mental disorder, these diagnoses should be
given instead of, or in addition to, PTSD. |
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Term
If severe, symptom response
patterns to the extreme stressor may |
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Definition
| warrant a separate diagnosis (e.g., dissociative amnesia). |
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Term
| Acute stress disorder is distinguished from PTSD because the |
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Definition
symptom pattern in acute stress disorder is restricted to a
duration of 3 days to 1 month following exposure to the traumatic event. |
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Term
Anxiety disorders and obsessivecompulsive disorder
In OCD, there are |
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Definition
recurrent intrusive thoughts, but these meet the definition of an obsession. In addition, the intrusive
thoughts are not related to an experienced traumatic event, compulsions are usually present, and other symptoms of PTSD
or acute stress disorder are typically absent. Neither the arousal and dissociative symptoms of panic disorder nor the
avoidance, irritability, and anxiety of generalized anxiety disorder are associated with a specific traumatic event. The
symptoms of separation anxiety disorder are clearly related to separation from home or family, rather than to a traumatic
event. |
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Term
Major depressive disorder
Major depression may or may not be preceded |
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Definition
by a traumatic event and should be diagnosed if other PTSD symptoms are
absent. Specifically, major depressive disorder does not include any PTSD Criterion B or C symptoms. Nor does it include a
number of symptoms from PTSD Criterion D or E. |
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Term
Personality disorders
Interpersonal difficulties that had their onset, or were greatly exacerbated, after exposure to a traumatic event |
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Definition
may be an
indication of PTSD, rather than a personality disorder, in which such difficulties would be expected independently of any
traumatic exposure. |
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Term
Dissociative disorders
Dissociative amnesia, dissociative identity disorder, and depersonalizationderealization disorder may or may not be
preceded by exposure |
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Definition
to a traumatic event or may or may not have cooccurring PTSD symptoms. When full PTSD criteria
are also met, however, the PTSD “with dissociative symptoms” subtype should be considered. |
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Term
Conversion disorder (functional neurological symptom disorder)
New onset of somatic symptoms within the context of posttraumatic distress might be |
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Definition
an indication of PTSD rather than
conversion disorder (functional neurological symptom disorder). |
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Term
Psychotic disorders
Flashbacks in PTSD must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in
schizophrenia, brief psychotic disorder, and other psychotic disorders; depressive |
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Definition
and bipolar disorders with psychotic
features; delirium; substance/medicationinduced disorders; and psychotic disorders due to another medical condition. |
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Term
When a brain injury occurs in the context of a traumatic event (e.g., traumatic accident, bomb blast,
acceleration/deceleration trauma), |
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Definition
| symptoms of PTSD may appear |
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Term
Comorbidity
Individuals with PTSD are 80% more likely than those without PTSD to |
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Definition
have symptoms that meet diagnostic criteria for at
least one other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders) (Kessler et al. 2005c).
Comorbid substance use disorder and conduct disorder (Kessler et al. 1995) are more common among males than among
females. |
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