*DSM-5 Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) in DSM-5

A. Criteria for PTSD Diagnosis

1. Exposure to Traumatic Events:

   • Directly experiencing or witnessing an event involving actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

     • Directly experiencing the traumatic event.

     • Witnessing, in person, the event as it occurred to others.

     • Learning that a close family member or friend was exposed to a traumatic event.

     • Experiencing repeated or extreme exposure to aversive details of the traumatic events (for example, first responders collecting human remains).

B. Intrusion Symptoms

1. Presence of One (or More) Intrusion Symptoms:

   • Recurrent, involuntary, and intrusive distressing memories of the traumatic event.

   • Recurrent distressing dreams related to the traumatic event.

   • Dissociative reactions (e.g., flashbacks) that feel as though the traumatic event is happening again.

   • 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 cues that symbolize or resemble an aspect of the traumatic event.

C. Avoidance Symptoms

1. Persistent Avoidance:

   • Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

   • Avoidance of or efforts to avoid external reminders (people, places, conversations, objects, situations) that arouse distressing memories, thoughts, or feelings about the traumatic event.

D. Negative Alterations in Cognitions and Mood

1. Negative Alterations:

   • Evidence of negative alterations in cognition and mood associated with the traumatic event, indicated by two (or more) of the following:

     • Inability to remember an important aspect of the traumatic event.

     • Persistent and exaggerated negative beliefs about oneself, others, or the world (e.g., "I am bad," "No one can be trusted").

     • Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others.

     • Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

     • Markedly diminished interest or participation in significant activities.

     • Feelings of detachment or estrangement from others.

     • Persistent inability to experience positive emotions (e.g., happiness, satisfaction).

E. Alterations in Arousal and Reactivity

1. Marked Alterations:

   • Evidence of marked alterations in arousal and reactivity associated with the traumatic event, shown by two (or more) of the following:

     • Irritable behavior and angry outbursts (with little or no provocation).

     • Reckless or self-destructive behavior.

     • Hypervigilance (heightened awareness/alertness).

     • Exaggerated startle response.

     • Problems with concentration.

     • Sleep disturbances (difficulty falling or staying asleep, or restless sleep).

F. Duration Criteria

1. Duration:

   • Symptoms must persist for more than one month.

G. Functional Impairment

1. Distress or Impairment:

   • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. Exclusions

1. Substance-Related Exclusions:

   • The symptoms are not attributable to the physiological effects of a substance (e.g., medication, alcohol, or drug abuse).

Dissociative Symptoms in PTSD

1. Depersonalization

• Defined as persistent or recurrent experiences of feeling detached from the mental processes or body, where one feels as if they are an outside observer of their own body or mental processes (e.g., feeling as if they are in a dream or having a sense of unreality or time moving slowly).

2. Derealization

• Defined as persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dream-like, distant, or distorted).

3. Considerations

• These experiences cannot be attributed to the effects of a substance.

Treatment Considerations and Implications

1. Psychological Interventions:

   • Strong focus on evidence-based therapies, including Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy.

   • Importance of creating a supportive environment for individuals experiencing PTSD.

2. Coping Strategies:

   • Development of healthy coping mechanisms to manage symptoms.

   • Exploration of mindfulness and relaxation techniques.

3. Ethical Considerations:

   • Consideration of informed consent in treatment plans.

   • Importance of trauma-informed care to avoid re-traumatization.

4. Real-World Implications:

   • Recognition of the societal impact of PTSD on mental health services, employment, and community support systems.

   • Need for increased awareness and education regarding trauma and its long-term effects on individuals and communities.