Psychiatry

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What is Trauma/Post-Traumatic Stress Disorder (PTSD)?

A trauma or post-traumatic stress disorder is a result of being exposed to actual or threatened death, serious injury, or sexual violence.

PTSD Criteria for Adults, Adolescents and Children

Individuals who are exposed to actual or threatened death, serious injury, or sexual violence in one or more of the following ways may experience trauma or post-traumatic stress disorder:

  • Directly experiencing the traumatic event
  • Witnessing, in person, the event as it occurred to others
  • Learning that the traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event

Presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event happened can occur for individuals with trauma or post-traumatic disorder:

  • Recurrent, involuntary and intrusive distressing memories of the traumatic event
  • Recurrent, distressing dreams in which the content and/or effect of the dream are related to the traumatic event.
  • Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring
  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  • Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

In children older than six, repetitive play, trauma-specific reenactment or frightening dreams without recognizable content may occur in which themes or aspects of the traumatic events are expressed.

Persistent Avoidance

Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by one or both of the following:

  • Avoidance of, or efforts to avoid, distressing memories, thoughts or feelings closely associated with the traumatic events
  • Avoidance of, or efforts to avoid, external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts or feelings closely associated with the traumatic events

Negative Alterations

Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

  • Inability to remember an important aspect of the traumatic event, typically due to dissociative amnesia and not to other factors such as head injury, alcohol or drugs
  • Persistent and exaggerated negative beliefs or expectations about oneself, others or the world
  • Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame themselves or others
  • Persistent negative emotional state (fear, horror, anger, guilt, shame)
  • Markedly diminished interest or participation in significant activities
  • Feelings of detachment or estrangement from others
  • Persistent inability to experience positive emotions (inability to experience happiness, satisfaction, loving feelings)

Alterations in Arousal and Reactivity

Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic events beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

  • Irritable behavior and angry outbursts with little or no provocation, typically expressed as verbal or physical aggression toward people or objects
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startled response
  • Problems with concentration
  • Sleep disturbance

Duration of Trauma

Most trauma durations last for more than one month. The disturbance causes clinically significant distress or impairment in overall functioning for the individual. Additionally, the traumatic event can cause clinically significant distress or impairment in relationships with parents, siblings, peers or other caregivers or with school behavior. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

What is an Adjustment Disorder?

An adjustment disorder is the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor. Symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

  • Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptoms severity and presentation
  • Significant impairment in overall functioning

To classify the stress-related disturbance as an adjustment disorder it must not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. Symptoms do not represent normal bereavement. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months.

Specifications

Low mood, tearfulness or feelings of hopelessness are predominant.

Nervousness, worry, jitteriness or separation anxiety is predominant.

A combination of depression and anxiety is experienced.

Disturbance of conduct is predominant.

Both emotional symptoms and a disturbance of conduct are predominant.