Posttraumatic Stress Disorder

1. The person has been exposed to a traumatic event in which both of the following were present:
   1. the 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
   2. the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
2. The traumatic event is persistently reexperienced in one (or more) of the following ways:
   
   1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

      Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

   2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
   3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).

      Note: In young children, trauma-specific reenactment may occur.

   4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
      physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
   1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
   2. efforts to avoid activities, places, or people that arouse recollections of the trauma
   3. inability to recall an important aspect of the trauma
   4. markedly diminished interest or participation in significant activities
   5. feeling of detachment or estrangement from others
   6. restricted range of affect (e.g., unable to have loving feelings)
   7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
   1. difficulty falling or staying asleep
   2. irritability or outbursts of anger
   3. difficulty concentrating
   4. hypervigilance
   5. exaggerated startle response
5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

• Acute: if duration of symptoms is less than 3 months
• Chronic: if duration of symptoms is 3 months or more

Specify if:

• With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Treatment

• The Expert Consensus Guideline Series on PTSD (very extensive desription of treatment options)
• A Guide for Patients and Families(short version for laypersons of the above)

Medication:

1. According to researchers at the Dallas Veterans Affairs Medical Center (VAMC), two drugs already on the market seem to relieve the major symptoms of combat-induced post-traumatic stress disorder (PTSD) in veterans. The antidepressant Nefazodone (Serzone) was found to reduce PTSD symptoms by almost 30 percent in 24 veterans who took the drug during a year-long study's eight-week treatment period. The VAMC study found that Serzone not only alleviated depression, but also the core symptoms of PTSD-flashbacks and nightmares.
2. There are also strong indications that the atypical antipsychotic Olanzapine (Zyprexa) aids in stabilizing the mood and reducing flashbacks in combat veterans suffering from PTSD. The VAMC has received a research grant to confirm these initial findings.
3. No drugs are currently designated for the treatment of PTSD. Although psychotherapy is commonly used to treat the disorder, its effectiveness is unproven.

Psychotherapy:

1. Although psychodynamic psychotherapy is commonly used to treat the disorder, its effectiveness is controversial.
2. Recently Exposure Therapy as part of a Cognitive Behavioral approach and/or EMDR Therapy (Eye Movement Desensitization and Reprocessing Therapy; Francine Shapiro) have in many cases been the treatment of choice with reports of very successful interventions.

• Depressed Mood
• Somatic or Sexual Dysfunction
• Guilt or Obsession
• Addiction

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which he/she needs to rule out to establish a precise diagnosis.

• Adjustment Disorder;
• Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the stressor;
• Another mental disorder (e.g., Brief Psychotic Disorder, Conversion Disorder, Major Depressive Disorder);
• Acute Stress Disorder;
• Obsessive-Compulsive Disorder;
• Schizophrenia;
• Other Psychotic Disorders;
• Mood Disorder With Psychotic Features;
• A delirium;
• Substance-Induced Disorders;
• Psychotic Disorders Due to a General Medical Condition;
• Malingering.