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DSM-IV PTSD Diagnostic Criteria

Current Diagnostic Criteria for Posttraumatic Stress Disorder
With the publication of the 4th edition of the DSM, the concept of trauma evolved from focusing on uncommon, highly adverse, external events to describing the specific characteristics of a traumatic event, including the individual’s psychological response to the event regardless of whether the event is rare or common. Specifically, the DSM-IV definition of a traumatic event has two criteria: the first is that a 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,’’ and the second is that ‘‘the person’s response involved intense fear, helplessness, or horror’’. Although exposure to a stressful event is an indispensable condition, exposure alone is insufficient for determining whether the experience is traumatic.
In DSM-IV, the critical determinant is the person’s cognitive and affective reactivity to an event. Therefore, if an event, such as a motor vehicle accident, involves ‘‘actual or threatened death or serious injury … to self or others’’ and also elicits severe and incapacitating psychological distress such as ‘‘intense fear, helplessness, or horror’’, the experience is traumatic. Studies of extreme situations have shown that in some individuals exposed to the most severe events, serious psychopathology develops, including but not limited to posttraumatic stress disorder (PTSD) (Dohrenwend, 1998). Indeed, traumatic experiences can lead to the development of several different disorders, including major depression, specific phobias, panic disorder, disorders of extreme stress not otherwise specified (DESNOS), personality disorders such as borderline personality disorder, and a range of physical symptoms, as well as PTSD. Although it is important to understand the range of potential syndromes and disorders associated with traumatic experiences, the focus of this chapter is to review and synthesize the epidemiologic and clinical research that examines the nature, assessment, and treatment of PTSD, specifically. The symptoms that characterize PTSD include distressing thoughts, feelings, and images that recapitulate the traumatic event, avoidance of stimuli associated with the event, emotional numbing of responsiveness, and a collection of symptoms that represent a persistent increase in stress and arousal (Keane, Weathers, & Foa, in press). The duration of the disturbance is longer than one month and ‘‘causes clinically significant distress or impairment in occupational, social, and other areas of functioning’’.
Specifically, PTSD is characterized by reexperiencing symptoms that include (1) recurrent and intrusive distressing recollections of the event, (2) recurrent distressing dreams of the event, (3) acting or feeling as if the event were recurring, (4) intense psychological distress at exposure to cues that symbolize the event, and (5) physiological reactivity to reminders of the experience. PTSD also involves persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness. Symptoms of avoidance and emotional numbing can include (1) efforts to avoid thoughts, feelings, or conversations about the event; (2) efforts to avoid activities, places or people associated with the trauma; (3) an inability to recall important details of the trauma; (4) a markedly diminished interest in formerly important activities; (5) a feeling of detachment or estrangement from other people; (6) a restricted range of affect; and (7) a sense of a shortened future. Symptoms of arousal that were not present before the traumatic event are also a component of the PTSD symptom profile. PTSD arousal symptoms can include (1) insomnia, (2) irritability or anger outbursts, (3) difficulty concentrating, (4) hypervigilance, and (5) an exaggerated and distressing startle response.

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