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Definition of PTSD DSM-IV

The DSM-IV-TR criteria for a diagnosis of  Post-traumatic stress disorder (PTSD) are that the individual has experienced or witnessed an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and that their immediate response involved intense fear, helplessness or horror. In the longer term, the individual must have experienced three clusters of symptoms for one month or more:

Intrusive memories :

The trauma is re-experienced through intrusive thoughts, flashbacks or nightmares. Such review may be deliberate as the individual ruminates about the traumatic event. Images may also spring unbidden to mind, in the form of flashbacks. These images often feel as real as the event, but may be fragmentary or partial. Emotions associated with the trauma may be relived with similar intensity to those felt at the time. Images are often described as if being in a film of the incident. Initially, the person may feel they are actually ‘in’ the fi lm: as they recover, they feel they are watching the fi lm as an outside observer. That is, they begin, almost literally, to feel more detached from the trauma.

Avoidance :

This may involve mental defence mechanisms including being unable to recall aspects of the trauma, emotional numbness, or detachment from others, as well as physically avoiding reminders of the trauma.

Arousal :

Persistent feelings of over-arousal that may be evidenced by irritability, being easily startled or hypervigilant, suffering insomnia, or having diffi culty concentrating. The triggers of PTSD vary widely, and include war experiences, childhood sexual and physical abuse, adult rape, and natural and technological disasters. Perhaps the most frequent cause of PTSD is road traffi c accidents: about 20 per cent of those involved develop some degree of PTSD. About 1 per cent of men and 2 per cent of women in the general population will have PTSD at any one time. Prevalence rates among groups that regularly encounter traumatic events are much higher. Bennett et al., for example, found a prevalence rate of 22 per cent among emergency ambulance personnel, rates among combat veterans from Vietnam are as high as 30 per cent for men and 27 per cent for women, while rates of PTSD among child soldiers in Africa approach 60 per cent. PTSD often begins within a few weeks of the precipitating event, but can be triggered by further trauma or life-events as diverse as trauma anniversaries, interpersonal losses, or changes in health status some time after the originating event. Of the three key symptoms, re-experiencing appears to decrease most rapidly. People in whom hyperarousal is the dominant symptom appear to have the worst prognosis. According to Freedy et al., an adult’s risk for distress will increase as the number of the following ‘risk’ factors increases:

female gender

aged 40 to 60 years old

little previous experience or training relevant to coping with disaster

low socio-economic status

for women, the presence of a spouse at the time of the trauma, especially if he is signifi cantly distressed

psychiatric history

severe exposure to the disaster, especially injury, life threat and extreme loss

living in a highly disrupted or traumatized community

secondary stress

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