ABSTRACT
Traumas as diverse as armed combat and road traffic accidents may produce an emotional destabilization of the individual. The duration of a person's destabilization can vary enormously from days, weeks, or months to a lifetime. Post-traumatic stress disorder (PTSD) is a particular manifestation of destabilization and the term can only be applied to a specific collection of symptoms that exist at least a month after the trauma. The diagnostic criteria for PTSD (American Psychiatric Association 1994) are shown below:
The person has been exposed to a traumatic event in which both of the following were present:
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;
the person's response involved intense fear, helplessness, or horror. Note: In children this may be expressed instead by disorganized or agitated behaviour.
The traumatic event is persistently re-experienced in one (or more) of the following ways:
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;
recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content;
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 intoxicated). Note: In young children trauma-specific re-enactment may occur;
(4) intense psychological distress at exposure to internal or external cues that symbolize 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.
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:
efforts to avoid thoughts, feelings or conversations associated with the trauma;
efforts to avoid activities, places or people that arouse recollections of the trauma;
inability to recall an important aspect of the trauma;
markedly diminished interest or participation in significant activities;
feeling of detachment or estrangement from others;
restricted range of affect (e.g. unable to have loving feelings);
sense of foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span).
Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
difficulty falling or staying asleep;
irritability or outbursts of anger;
difficulty concentrating;
hypervigilance;
exaggerated startle response.
Duration of the disturbance (symptoms in criteria B, C and D ) is more than one month.
The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
