What is PTSD?Definition of Post-traumatic Stress Disorder
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a guide in understanding clusters of symptoms so that they know how to treat different clients. The DSM has gone through a number of revisions through the years, and recently the 5th edition was released. Posttraumatic Stress Disorder (PTSD) was one of the diagnoses that received some revisions
PTSD used to be considered a type of anxiety disorder and in this edition was moved into a new category: “Trauma and Stress-related Disorders”. This could help de-stigmatize PTSD since it is no longer an anxiety related mental illness, but a disorder connected to an external event.
The criteria for PTSD include specifying qualifying experiences of traumatic events, four sets of symptom clusters, and two subtypes. There are also requirements around duration of symptoms, how it impacts one’s functioning, and ruling out substance use and medical illnesses.
Criterion A: Traumatic event
Trauma survivors must have been exposed to actual or threatened:
- serious injury
- sexual violence
The exposure can be:
- indirect, by hearing of a relative or close friend who has experienced the event—indirectly experienced death must be accidental or violent
- repeated or extreme indirect exposure to qualifying events, usually by professionals—non-professional exposure by media does not count
Many professionals who work in trauma differentiate between “big T-traumas,” the ones listed above, and “little-t traumas.” Little-t traumas can include complicated grief, divorce, non-professional media exposure to trauma, or childhood emotional abuse, and clinicians recognize that these can result in post-traumatic stress, even if they don’t qualify for the PTSD diagnosis.
There is no longer a requirement that someone had to have an intense emotional response at the time of the event. This requirement excluded many veterans and sexual assault survivors in the past.
Criterion B: Intrusion or Re-experiencing
These symptoms envelope ways that someone re-experiences the event. This could look like:
- Intrusive thoughts or memories
- Nightmares related to the traumatic event
- Flashbacks, feeling like the event is happening again
- Psychological and physical reactivity to reminders of the traumatic event, such as an anniversary
Criterion C: Avoidant symptoms
Avoidant symptoms describe ways that someone may try to avoid any memory of the event, and must include one of the following:
- Avoiding thoughts or feelings connected to the traumatic event
- Avoiding people or situations connected to the traumatic event
Criterion D: Negative alterations in mood or cognitions
This criterion is new, but captures many symptoms that have long been observed by PTSD sufferers and clinicians. Basically, there is a decline in someone’s mood or thought patterns, which can include:
- Memory problems that are exclusive to the event
- Negative thoughts or beliefs about one’s self or the world
- Distorted sense of blame for one’s self or others, related to the event
- Being stuck in severe emotions related to the trauma (e.g. horror, shame, sadness)
- Severely reduced interest in pre-trauma activities
- Feeling detached, isolated or disconnected from other people
Criterion E: Increased arousal symptoms
Increased arousal symptoms are used to describe the ways that the brain remains “on edge,” wary and watchful of further threats. Symptoms include the following:
- Difficulty concentrating
- Irritability, increased temper or anger
- Difficulty falling or staying asleep
- Being easily startled
Criteria F, G and H
These criteria all describe the severity of the symptoms listed above. Basically, they have to have lasted at least a month, seriously affect one’s ability to function and can’t be due to substance use, medical illness or anything except the event itself.
Dissociation has now been set apart from the symptom clusters, and now its presence can be specified. While there are several types of dissociation, only two are included in the DSM:
- Depersonalization, or feeling disconnected from oneself
- Derealization, a sense that one’s surroundings aren’t real
About this description
This description of the diagnosis is not meant to help people diagnose themselves, but to better understand what PTSD is, and how it can impact someone’s life. If you feel that you may have PTSD, please see a professional who can talk with you about your experiences, and offer you ways to receive treatment and support. Many thanks to the National Center for PTSD for providing the criteria for PTSD on their website.
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I have worked closely with Mark for several years, supervising him through to and beyond his accreditation as an EMDR Therapist. Mark is a highly committed and skilled therapist with a special interest in the treatment of traumatic stress-related difficulties, especially in the ex-military population.Professor Jamie Hacker Hughes