Post-Traumatic Stress Disorder (PTSD) Support Group
Find support with others who have gone through a traumatic experience. Whether you have chronic or acute PTSD, we are here for you.
Posttraumatic Stress Disorder DSM-IV Diagnosis & Criteria
309.81 Posttraumatic Stress Disorder
Diagnostic Features
The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).
Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.
The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for a woman who was raped in an elevator).
Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situation, or people who arouse recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).
The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3).
Specifiers
The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder:
Acute. This specifier should be used when the duration of symptoms is less than 3 months.
Chronic. This specifier should be used when the symptoms last 3 months or longer.
With Delayed Onset. This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.
Associated Features and Disorders
Associated descriptive features and mental disorders. Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job. The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture): impaired complaints; feelings of ineffectiveness, shame, despair, or hopelessness; feeling permanently damaged; a loss of previously sustained beliefs, hostility; social withdrawal; feeling constantly threatened; impaired relationships with others; or a change from the individual's previous personality characteristics.
There may be increased risk of Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Social Phobia, Specific Phobia, Major Depressive Disorder, Somatization Disorder, and Substance-Related Disorders. It is not known to what extent these disorders precede or follow the onset of Posttraumatic Stress Disorder.
Associated laboratory findings. Increased arousal may be measured through studies of autonomic functioning (e.g., heart rate, electromyography, sweat gland activity).
Associated physical examination findings and general medical conditions. General medical conditions may occur as a consequence of the trauma (e.g., head injury, burns).
Specific Culture and Age Features
Individuals who have recently emigrated from areas of considerable social unrest and civil conflict may have elevated rates of Posttraumatic Stress Disorder. Such individuals may be especially reluctant to divulge experiences of torture and trauma due to their vulnerable political immigrant status. Specific assessments of traumatic experiences and concomitant symptoms are needed for such individuals.
In younger children, distressing dreams of the event may, within several weeks, change into generalized nightmares of monsters, of rescuing others, or of threats to self or others. Young children usually do not have the sense that they are reliving the past; rather, the reliving of the trauma may occur through repetitive play (e.g., a child who was involved in a serious automobile accident repeatedly reenacts car crashes with toy cars). Because it may be difficult for children to report diminished interest in significant activities and constriction of affect, these symptoms should be carefully evaluated with reports from parents, teachers, and other observers. In children, the sense of a foreshortened future may be evidenced by the belief that life will be too short to include becoming an adult. There may also be "omen formation" - that is, belief in an ability to foresee future untoward events. Children may also exhibit various physical symptoms such as stomachaches and headaches.
Prevalence
Community-based studies reveal a lifetime prevalence for Posttraumatic Stress Disorder ranging from 1% to 14%, with the variability related to methods of ascertainment and the population sampled. Studies of at-risk individuals (e.g., combat veterans, victims of volcanic eruptions or criminal violence) have yielded prevalence rates ranging from 3% to 58%.
Course
Posttraumatic Stress Disorder can occur at any age, including childhood. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before symptoms appear. Frequently, the disturbance initially meets criteria for Acute Stress Disorder (see p. 429) in the immediate aftermath of the trauma. The symptoms of the disorder and the relative predominance of reexperiencing, avoidance, and hyperarousal symptoms may vary over time. Duration of the symptoms varies, with complete recovery occurring within 3 months in approximately half of cases, with many others having persisting symptoms for longer than 12 months after the trauma.
The severity, duration, and proximity of an individual's exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of Posttraumatic Stress Disorder. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme.
Differential Diagnosis
In Posttraumatic Stress Disorder, the stressor must be of an extreme (i.e., life-threatening) nature. In contrast, in Adjustment Disorder, the stressor can be of any severity. The diagnosis of Adjustment Disorder is appropriate both for situations in which the response to an extreme stressor does not meet the criteria for Posttraumatic Stress Disorder (or another specific mental disorder) and for situations in which the symptom pattern of Posttraumatic Stress Disorder occurs in response to a stressor that is not extreme (e.g., spouse leaving, being fired).
Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily be attributed to Posttraumatic Stress Disorder. Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the stressor do not meet criteria for the diagnosis of Posttraumatic Stress Disorder and require consideration of other diagnoses (e.g., Brief Psychotic Disorder, Conversion Disorder, Major Depressive Disorder), these diagnoses should be given instead of, or in addition to, Posttraumatic Stress Disorder.
Acute Stress Disorder is distinguished from Posttraumatic Stress Disorder because the symptom pattern in Acute Stress Disorder must occur within 4 weeks of the traumatic event and resolve within that 4-week period. If the symptoms persist for more than 1 month and meet criteria for Posttraumatic Stress Disorder, the diagnosis is changed from Acute Stress Disorder to Posttraumatic Stress Disorder
In Obsessive-Compulsive Disorder, there are recurrent intrusive thoughts, but these are experienced as inappropriate and are not related to an experienced traumatic event. Flashbacks in Posttraumatic Stress Disorder must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in Schizophrenia, other Psychotic Disorders, Mood Disorder With Psychotic Features, a delirium, Substance-Induced Disorders, and Psychotic Disorders Due to a General Medical Condition.
Malingering should be ruled out in those situations in which financial remuneration, benefit eligibility, and forensic determinations play a role.
309.81 DSM-IV Criteria for Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following have been 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 upon 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 one 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
http://www.mental-health-today.com/ptsd/dsm.htm
309.81 Posttraumatic Stress Disorder
Diagnostic Features
The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).
Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.
The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for a woman who was raped in an elevator).
Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situation, or people who arouse recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).
The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3).
Specifiers
The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder:
Acute. This specifier should be used when the duration of symptoms is less than 3 months.
Chronic. This specifier should be used when the symptoms last 3 months or longer.
With Delayed Onset. This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.
Associated Features and Disorders
Associated descriptive features and mental disorders. Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job. The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture): impaired complaints; feelings of ineffectiveness, shame, despair, or hopelessness; feeling permanently damaged; a loss of previously sustained beliefs, hostility; social withdrawal; feeling constantly threatened; impaired relationships with others; or a change from the individual's previous personality characteristics.
There may be increased risk of Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Social Phobia, Specific Phobia, Major Depressive Disorder, Somatization Disorder, and Substance-Related Disorders. It is not known to what extent these disorders precede or follow the onset of Posttraumatic Stress Disorder.
Associated laboratory findings. Increased arousal may be measured through studies of autonomic functioning (e.g., heart rate, electromyography, sweat gland activity).
Associated physical examination findings and general medical conditions. General medical conditions may occur as a consequence of the trauma (e.g., head injury, burns).
Specific Culture and Age Features
Individuals who have recently emigrated from areas of considerable social unrest and civil conflict may have elevated rates of Posttraumatic Stress Disorder. Such individuals may be especially reluctant to divulge experiences of torture and trauma due to their vulnerable political immigrant status. Specific assessments of traumatic experiences and concomitant symptoms are needed for such individuals.
In younger children, distressing dreams of the event may, within several weeks, change into generalized nightmares of monsters, of rescuing others, or of threats to self or others. Young children usually do not have the sense that they are reliving the past; rather, the reliving of the trauma may occur through repetitive play (e.g., a child who was involved in a serious automobile accident repeatedly reenacts car crashes with toy cars). Because it may be difficult for children to report diminished interest in significant activities and constriction of affect, these symptoms should be carefully evaluated with reports from parents, teachers, and other observers. In children, the sense of a foreshortened future may be evidenced by the belief that life will be too short to include becoming an adult. There may also be "omen formation" - that is, belief in an ability to foresee future untoward events. Children may also exhibit various physical symptoms such as stomachaches and headaches.
Prevalence
Community-based studies reveal a lifetime prevalence for Posttraumatic Stress Disorder ranging from 1% to 14%, with the variability related to methods of ascertainment and the population sampled. Studies of at-risk individuals (e.g., combat veterans, victims of volcanic eruptions or criminal violence) have yielded prevalence rates ranging from 3% to 58%.
Course
Posttraumatic Stress Disorder can occur at any age, including childhood. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before symptoms appear. Frequently, the disturbance initially meets criteria for Acute Stress Disorder (see p. 429) in the immediate aftermath of the trauma. The symptoms of the disorder and the relative predominance of reexperiencing, avoidance, and hyperarousal symptoms may vary over time. Duration of the symptoms varies, with complete recovery occurring within 3 months in approximately half of cases, with many others having persisting symptoms for longer than 12 months after the trauma.
The severity, duration, and proximity of an individual's exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of Posttraumatic Stress Disorder. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme.
Differential Diagnosis
In Posttraumatic Stress Disorder, the stressor must be of an extreme (i.e., life-threatening) nature. In contrast, in Adjustment Disorder, the stressor can be of any severity. The diagnosis of Adjustment Disorder is appropriate both for situations in which the response to an extreme stressor does not meet the criteria for Posttraumatic Stress Disorder (or another specific mental disorder) and for situations in which the symptom pattern of Posttraumatic Stress Disorder occurs in response to a stressor that is not extreme (e.g., spouse leaving, being fired).
Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily be attributed to Posttraumatic Stress Disorder. Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the stressor do not meet criteria for the diagnosis of Posttraumatic Stress Disorder and require consideration of other diagnoses (e.g., Brief Psychotic Disorder, Conversion Disorder, Major Depressive Disorder), these diagnoses should be given instead of, or in addition to, Posttraumatic Stress Disorder.
Acute Stress Disorder is distinguished from Posttraumatic Stress Disorder because the symptom pattern in Acute Stress Disorder must occur within 4 weeks of the traumatic event and resolve within that 4-week period. If the symptoms persist for more than 1 month and meet criteria for Posttraumatic Stress Disorder, the diagnosis is changed from Acute Stress Disorder to Posttraumatic Stress Disorder
In Obsessive-Compulsive Disorder, there are recurrent intrusive thoughts, but these are experienced as inappropriate and are not related to an experienced traumatic event. Flashbacks in Posttraumatic Stress Disorder must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in Schizophrenia, other Psychotic Disorders, Mood Disorder With Psychotic Features, a delirium, Substance-Induced Disorders, and Psychotic Disorders Due to a General Medical Condition.
Malingering should be ruled out in those situations in which financial remuneration, benefit eligibility, and forensic determinations play a role.
309.81 DSM-IV Criteria for Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following have been 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 upon 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 one 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
http://www.mental-health-today.com/ptsd/dsm.htm
My Initial Intake was an hour with the Pdoc...but I am sure my future appt's wouldn't be that long.
But, I know I could definitely have enough to rattle off with him about me and PTSD...and even share some of my enlightening findings and helpful resources with him.
I have thought about doing that...so if others with PTSD come in, they can take a peek at the websites that I recommend, and other helpful things.
Just trying to find my passion again...I like helping people, and educating...I think educating is my BIGGIE...I want to increase the knowledge base...that's how I was at work.
I tried what I could to boost critical thinking skills, and if I found something unique...I'd share it. That's just me...I like to spread knowledge...and always wanted to be a Nurse Educator in the hospital, but no slot opened on my unit. I would like to teach at the College level as well, though only have my BSN, but can do clinicals...and can teach classes at the 2-year degree schools.
Oh...Dreams...at least I have some passion back in my life, it's PTSD/Abuse Awareness right now.
I am horrified about a GP saying what he said about "living with it"
I too believe strongly the more we understand about PTSD symptoms and the way it affects our behaviours etc. the easier it is to live with, tame or eradicate (with help). There is a wealth of information in forum and info sites (some government health sites are really good too).
There are very similar signs and symptoms between PTSD and Bipolar. It would take a professional to really weed it out, which one you have...but it's possible to have both too...though the stories I have read from other DS'ers with both PTSD and Bipolar 1, there mood swings were extreme. There is a lesser form of Bipolar, called Bipolar 2...and this is the form I believe is what can look like PTSD.
I never received any extensive testing to diagnose my PTSD. My PTSD was diagnosed by my symptoms and history of trauma.
The DSM-IV is a book that lists all Psych Disorders and their symptoms...for the PTSD DSM-IV...it looks exactly as posted above. Each different Psych Disorder has a code that corresponds with the code written in the DSM-IV. This is what they write on your 'receipt' that you get after your visit. The 309.81 is the code for PTSD.
Psychiatrist's and Psychologist's follow the DSM-IV criteria to make the diagnosis of PTSD, or any other Mental Health Issue.
Now, there is additional testing that can be performed to quantify how the Trauma has affected your Brain. One is called Neuro-Psych Testing. I had this done. But, not everyone that is diagnosed with PTSD has this testing done. And, I don't believe it's a required test, but it does add weight if you have Cognitive Dysfunction.
I agree, you need a Pdoc that is knowledgeable about PTSD to treat you. Not every Pdoc has the knowledge to treat PTSD, and is not up-to-date on the Current Research going on...and there's lots of it going on due to the War. We civilians can also reap the rewards from this Research!
And, Winndi...if you said yes to all of them...then most likely your diagnosis is correct...you have PTSD.
I know I need to go out to sidran and do a little more research, but time is crazy for me right now. Thank you for posting this and then bumping it, because I missed the initial post.
I first read the DSM-IV on PTSD a few months before my diagnosis. At that time, there was not the spitting out of "acute stress disorder" for trauma that was not personally injurious or life-threatening. Things like job loss and marraige breakup (not due to abuse) WERE diagnosed as PTSD. Although my abuse was verbal/emotional, there were threats to my welfare, and at the end rages where I seriously felt that my physical safety was in danger, so I know that I would still fit the profile of PTSD. I was diagnosed after a serious flashback, an hour's session with a therapist, the MMPI and at least 2 other personality profile tests that took about 2 1/2 hours, and a 45 minute intake with a pdoc. After the meds were prescribed and stabilized and follow-up done, the resulting effects of the meds and therapy were evaluated to confirm the diagnosis. It was only after the diagnosis was confirmed that I was told.
Since I haven't got time right now to do my own research, I was wondering if you could help me short-cut a couple of questions I have related to the current DSM-IV:
1. What is the current status of the designation of complex PTSD? It is my understanding that there is an attempt to separate those that suffer from repeated trauma (war veterans, victims of abusive relationships or child abuse, hostage and torture) from those who had a single significant trauma (accidents, natural disasters, assault not related to abuse, etc.) because the treatments and potential outcomes can be dramatically different. Is this a separate diagnosis, a diagnosis that is not yet defined or a clinical way to associate the trauma to the disorder?
2. At the time I was studying it in grad school, a symptom that was going to be added was an extreme "time warp" or the inability to discern the passage of time. It would have to be extreme, where you couldn't determine if something happened yesterday or 6 months ago, or even a few minutes ago vs. several hours, but it has proven to be something that trauma victims that went into "slow motion" mode during the actual trauma (common in car crashes, for example) often experience as an after-effect. I didn't see that in this DSM-IV list of symptoms and was wondering if you know anything about that. I believe my mother has some of that due to a serious auto accident she was involved in and have always suspected she has some form of PTSD related to that event.
Again, thanks for posting this. Knowledge is power as far as my own healing is concerned, and it was nice to be able to read through it again.
One thing that was posted awhile ago that impacts PTSD is HOW the Trauma affected you personally. The Psychological Impact it had on you.
So, as to the job loss, marriage break-up-The Verbal and Emotional Abuse...it seemed to impact you psychologically...and that is a component of PTSD.
The Article I posted was from Sidran...Let me find it real quick:
What is Psychological Trauma?
http://www.sidran.org/sub.cfm?contentID=88&sectionid=4
I believe that Complex PTSD is NOT currently included in the DSM IV...though the diagnosis is currently being used by Pdoc's, and probably will show up in the next edition of the DSM.
The Acute Stress Disorder is diagnosed after say a car wreck or some other trauma...but the key feature of this disorder is that the effects of the Trauma are short-lived...and do not continue to burden one.
For example, my DH was in a car wreck last December. It spinned his world around right after the crash and for a short time afterwards. He didn't want to drive a car for a short period of time b/c of the crash. He was awakened that life is short, and family is so important.
But, this lasted about a month, and it went away on its own. Acute Stress Disorder.
I believe you are correct when you described Complex PTSD..."It is my understanding that there is an attempt to separate those that suffer from repeated trauma (war veterans, victims of abusive relationships or child abuse, hostage and torture) from those who had a single significant trauma (accidents, natural disasters, assault not related to abuse, etc.) because the treatments and potential outcomes can be dramatically different. Is this a separate diagnosis..."
Like I mentioned above...in a sense it's a separate diagnosis, a higher degree of PTSD...but is not currently included in the current edition of the DSM IV. Though, I have seen many people on DS saying they've been diagnosed with Complex PTSD...so the diagnosis is being used even though it's not listed in the DSM-IV.
The DSM has continually been updating the criteria of PTSD at each new edition.
And to address question # 2, the 'time warp'...that sounds like Dissociation to me. I didn't see it listed above either, though I believe it is a symptom of PTSD. Many people with PTSD experience this. But, from what I just looked up, it seems to be a separate diagnosis in the DSM-IV.
Here's an article on What is Disassociative Disorder from Sidran:
http://www.sidran.org/sub.cfm?contentID=75&sectionid=4
Though, this article mentions Multiple Personalities...this can be a different subset of Dissociation. There's a few different forms of Dissociation.
Here's an article that discusses a bit of Dissociation:
http://ajp.psychiatryonline.org/cgi/content/full/156/11/1677#SEC3
And
http://psychology.wikia.com/wiki/Dissociative_Identity_Disorder
It's quite possible your Mom may have some signs of PTSD. I think my Mom has some signs of PTSD from being in Denial of my SA...after truly coming out again last year, she seems mentally cloudy and different.
I hope that helps some!
Oh, I was diagnosed by a therapist first with PTSD. Then saw the Pdoc, and gave me a diagnosis of PTSD vs Bipolar 2. I think she only sent me Neuro-Psych Testing b/c I kept complaining of memory issues...and since I was a Nurse, I need my brain. I had the MMPI and a few other testing scales, plus extensive cognitive testing.
Here's the crappy part...My Pdoc wanted me to go back to work BEFORE getting my Neuro-Psych Testing Results back. Can you believe that?? I kept telling her I felt like a liability to go back to work, she ignored me. She even wrote me a slip to go back to work! I did NOT go back to work...I went with my gut feeling!
Yet, my Neuro-Psych testing proved I had Cognitive Dysfunction, and should be on Disability. It also weeded out the Bipolar 2. Which I knew I wasn't Bipolar, when I heard PTSD...I knew that was me.
She refused to agree with me being on any type of Disability.
After my Neuro-Psych testing came back, I dumped that Pdoc. She was trying to be too in control and authoritative...and that personality with mine did NOT mix well.
She even told me that I do not look depressed! I call her the Witchy Pdoc ;)
By the way, as a funny asside, the pdoc that diagnosed me told me he knew I was depressed just by looking at me - he didn't need the results of all that testing. He still interviewed me for about 45 minutes to get a handle on what else I was dealing with, and the debilitating form of anxiety came out in that as the greater concern than even the depression. At the time, he also knew (or at least guessed) that it was only a part of the bigger and broader diagnosis of PTSD. It kinda took me aback though, just like with yours.