7.1 Trauma-Related Disorders: DSM-5 Criteria for PTSD & Key Concepts

Identify and differentiate trauma-related disorders (esp. PTSD vs. Acute Stress Disorder).
Recognize short- and long-term outcomes following trauma.
List factors that predispose individuals to maladjustment.
Review evidence-based interventions/treatments for trauma symptoms.

DSM-5 criteria discussed apply to adults, adolescents, and children older than $6$ .
Children $\le 6$ have separate, developmentally sensitive criteria (not covered here).

Acute Stress Disorder: symptoms emerge 3 days – $1$ month post-trauma.
Post-Traumatic Stress Disorder: symptom cluster persists $>1$ month.
- Many criteria overlap; chronicity is the primary differentiator.

Direct experience of actual or threatened death, serious injury, or sexual violence.
Witnessing such events in person as they occur to others.
Learning that violent/accidental trauma befell a close family member or friend.
Repeated or extreme exposure to aversive details of trauma (e.g., first responders, crime-scene technicians).
- Exclusion: Media exposure (TV, movies, internet) does not count unless job-related.

Recurrent, involuntary, intrusive distressing memories.
- Children may reenact themes in repetitive play.
Recurrent distressing dreams with content or affect of the event.
- Children may report frightening dreams with unrecognizable content.
Dissociative reactions (flashbacks); continuum from brief lapses to complete loss of present awareness.
- Children may incorporate trauma themes into play episodes.
Intense/prolonged psychological distress when exposed to cues (internal or external).
Marked physiological reactions to such cues (↑ heart rate, sweating, tremors, etc.).

Efforts to avoid distressing memories, thoughts, feelings about the trauma.
Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that evoke trauma-related distress.

Inability to recall important aspects of the trauma (dissociative amnesia; not due to head injury/substances).
Persistent, exaggerated negative beliefs/expectations about self, others, world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My nervous system is ruined.”).
Distorted cognitions about cause/consequence leading to self- or other-blame.
Persistent negative emotional state: fear, horror, anger, guilt, shame.
Markedly diminished interest/participation in significant activities.
Feelings of detachment or estrangement (isolation component often heightened in sexual-assault survivors; linked to low self-compassion).
Persistent inability to experience positive emotions (happiness, satisfaction, love).

Irritable behavior & angry outbursts (verbal/physical aggression) with little provocation.
Reckless or self-destructive behavior (e.g., substance abuse, drunk driving).
Hypervigilance.
Exaggerated startle response (jumpiness to loud noises, sudden movements).
Problems with concentration.
Sleep disturbance: difficulty falling/staying asleep, restless or poor-quality sleep.

Clinically significant distress or impairment in social, occupational, or other important areas.

Not attributable to the physiological effects of substances (medication, alcohol, drugs) or another medical condition.

Depersonalization: feeling detached from oneself; outside observer; unreality of body/self; time slowing (“I’m not real,” “This isn’t my body”).
Derealization: unreality/dreamlike/distant perception of surroundings (“The world looks fake or far away”).
Transient episodes of depersonalization/derealization (lasting seconds–minutes) can be normal in the general population; in PTSD they are persistent and linked to the trauma.
Must not be better explained by substances (e.g., alcohol blackout, psychedelics) or medical conditions (e.g., complex partial seizures).

Full diagnostic criteria not met until ≥ $6$ months post-event.
- Some symptoms may appear immediately but remain subthreshold until later.

Developmental regression in children (e.g., loss of language, enuresis/bedwetting after potty-training).
Auditory pseudo-hallucinations: hearing one’s own thoughts spoken aloud in various voices.
Paranoid ideation.
After prolonged, repeated, severe trauma (childhood abuse, torture):
- Emotion-regulation deficits.
- Unstable interpersonal relationships.
- Prominent dissociative phenomena.
Violent death of close other → symptoms of Prolonged Grief Disorder may co-occur with PTSD.

Media exposure alone does not qualify as Criterion A ⇒ avoids over-pathologizing everyday news consumption.
Clinicians must consider differential diagnoses (substance use, medical conditions) to prevent mislabeling.
Understanding isolation and self-blame components is critical for trauma-informed, compassionate care, especially in sexual-assault survivors.
First-responder professions warrant occupational mental-health supports due to Criterion A4 exposure.

Though not detailed in the transcript, evidence-based modalities include Trauma-Focused CBT, EMDR, exposure therapies, pharmacotherapy (e.g., SSRIs, prazosin for nightmares).
Early intervention during the ASD window (first $4$ weeks) may reduce progression to chronic PTSD.

Exposure (A) + Intrusion (B) + Avoidance (C) + Negative Mood/Cognition (D) + Hyperarousal (E)
Disturbance > $1$ month (F) with distress/impairment (G), not due to substances/medical (H).
Add specifiers for Dissociation or Delayed Expression when applicable.