PTSD - DSM-5 Criteria

NUR 484, MCSON, Mrs. Bryant

what is traumatic exposure?

The person was exposed to: death, threatened death, actual or

threatened serious injury, or actual or threatened sexual violence,

in one (or more) of the following ways:

1. Direct exposure

2. Witnessing the trauma

3. Learning that a close relative or friend was exposed to trauma

4. Indirect exposure to aversive details of the trauma (e.g., first

responders)

the traumatic event is persistently re-experienced in what ways?

• Intrusive thoughts or memories

• Nightmares related to the trauma

• Flashbacks

• Emotional distress after exposure to reminders

• Physical reactivity after exposure to reminders

avoidance of trauma-related stimuli after the trauma, in

the following way(s):

• Avoiding thoughts, feelings, or conversations about the

trauma

• Avoiding reminders (people, places, conversations,

activities, objects, or situations)

what are some negative alterations in cognitions and mood?

• Inability to recall key features of the trauma

 Persistent negative beliefs about oneself or the world

 Distorted blame of self or others

 Persistent negative emotions (fear, anger, guilt, etc.)

 Diminished interest in activities

 Feeling alienated

 Inability to experience positive emotions

what are some alterations in arousal and reactivity?

• Irritability or aggressive behavior

 Self-destructive or reckless behavior

 Hypervigilance

 Exaggerated startle response

 Problems in concentration

 Sleep disturbances

symptoms should last more than ___ month to be classified as PTSD

1

in order to be classified as PTSD, the symptoms must cause significant distress and/or functional impairment (social, occupational, etc.)

in order to be classified as PTSD, the symptoms should not be due to medications, substance use, or other illnesses

what are some nursing interventions for PTSD?

• Listen to descriptions of recollections and acknowledge troubling

symptoms

 Refrain from encouraging patient to talk if it increases anxiety, but remain

with them – therapeutic value of silence

 Conduct a suicide assessment, observe for self-destructive/harmful

thoughts and behaviors

 Protect patient and others from any out-of-control anger and aggression

 Refer patient to therapists or support groups specializing in PTSD

 Monitor for comorbid conditions (common: older –depression, younger –

drug/alcohol abuse)

 Attempt to decrease stigma

 Caregiver concern – secondary traumatization

what is the treatment for PTSD?

• Psychotherapy (cognitive, behavioral, EMDR, exposure)

 (SSRIs), including sertraline and paroxetine

 Short course of antipsychotics or antianxiety medications

 Sleep aids/anti-insomnia drugs

 Prazosin – antihypertensive used off-label to reduce nightmares

 Therapy can be used alone or in combination with medications

 Long-term use of benzodiazepines is contraindicated