Post-traumatic stress disorder

by TheEditor

Categories: Diagnosis

PTSD is a diagnosis that is quite often made by psychiatrists after a single interview for say an hour. It is important that additional information is gathered and evaluated in relation to the diagnostic criteria. DSM-IV is quite demanding in the clinical features that compose the syndrome.

Our assessment of a person with who has been exposed to trauma will probably be at least 2.5 hours. We gather much background information and if necessary may interview reliable informants to corroborate symptoms, loss of mental function and other relevant detail. Diagnosis is not a tick-box exercise. We explore the reality of the clients symptoms and connect that to any functional issues.

Our assessments may include psychometric testing as an adjunct to clinical diagnosis. See the criteria below.

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder in DSM-IV:

  1. The person has been exposed to a traumatic event in which both of the following were 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 disorganised or agitated behaviour
  2. 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 recognisable 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 on 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 symbolise or resemble an aspect of the traumatic event
    5. physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event
  3. 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)
  4. 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
  5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
  6. 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 mor

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Other posts that may interest you...

Car repairs v human repairs

Today I was at my Citroen garage to have a malfunctioning driver’s side door handle replaced. I had problems getting in and out of the car. The problematic door handle ...

Read more

A Closer Look at Personality Disorders

The WHO’s ICD-11 “Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders“, the latest revision, building on ICD-10, has introduced rigorous requirements for personality disorder diagnosis. [This ...

Read more

Complex PTSD

Complex Post-Traumatic Stress Disorder (Complex PTSD or cPTSD) represents a profound and multifaceted condition categorised within the trauma and stressor-related disorders in the ICD-11. Emerging out of exposure to severe, ...

Read more