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  • PTSD Symptoms, Signs, Causes, DSM Criteria Checklist

    Psychiatrists believe that PTSD can only be correctly diagnosed after at least a month has passed since the traumatic event. Before then the condition is considered a post-traumatic stress, but not yet post traumatic stress disorder. In addition the person must display all 3 classes of PTSD symptoms & necessary bases to differentiate it from other mental disorders.

    • Class 1 symptoms: the sufferer re-experiences the traumatic incident
      ex. nightmares, flashbacks.
    • Class 2 symptoms: the sufferer displays avoidance, wants to stay away from anything that may possibly remind her/him of the trauma. May also display lack of responsiveness or interest to all life circumstances.
      ex. sights, smells, sounds, conversations associated or reminding of trauma, unable to enjoy once joyful activities or have loving feelings
    • Class 3 symptoms: hyperarousal
      ex.  irritable all the time or inability to sleep.

    Despite the fact that above mentioned 3 classes of PTSD symptoms are most often present immediately after the traumatic incident, there are times when they show up much later, resulting in delayed-onset PTSD.


    Diagnostic criteria for Posttraumatic Stress Disorder from DSM IV (Diagnostic and Statistical Manual of Mental Disorders)

    • A. 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 disorganized or agitated behavior
    • B. The traumatic event is persistently re-experienced 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 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 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 1 month.
    • F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


    Onset and duration of PTSD symptoms are set by the following specifiers:

    • Acute – when the duration of symptoms is shorter than 3 months.
    • Chronic – when the symptoms last three months or longer.
    • With Delayed Onset – between the traumatic event and the onset of the symptoms there is at least 6 month period.


    PTSD Causes – Post-Traumatic Stress Disorder


    Directly experienced traumatic events include:

    • military combat
    • violent personal assault such as:
      sexual assault
      physical attack
      mugging etc.
    • being kidnapped
    • being taken hostage
    • terrorist attack
    • torture
    • incarceration as a prisoner of war or in a concentration camp
    • natural/manmade disasters
    • severe automobile accidents
    • being diagnosed with a life-threatening illness
    • other causes


    Sexually traumatic events for children include:
    • Inappropriate sexual experiences with no threatening, actual violence or injury
    • Other traumatic developmental experiences with no threatening, actual violence or injury


    Indirectly experienced traumatic events include:

    Witnessed events:
    • observing the serious injury or unnatural death of another person due to violent assault
    • accident
    • war and disaster
    • unexpectedly witnessing a dead body or body parts
    • other traumatic witnessed events
    Events experienced by others & learned about include:
    • violent personal assault
    • serious accident
    • serious injury experienced by a family member/close friend
    • learning about the sudden death of a family member/close friend
    • learning one’s child has a life-threatening disease
    • other learned traumatic events

    PTSD symptoms are  usually more severe or long lasting when the stressor is caused by a human(s) (e.g., torture, rape etc.). The likelihood of developing PTSD usually increases as the intensity & physical proximity to the stressor increase.