Some Symptoms of PTSD
A Short History of PTSD
Before Posttraumatic Stress Disorder (PTSD) was formally recognized as a diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders or (DSM) which is the standard classification of mental disorders used by mental health professionals in the United States, PTSD was known through the history by other very descriptive names after certain events. Civil War Veterans were said to suffer of 'irritable heart' or 'soldiers heart'. A survivor of a person involved in a railroad accident when it was a new mode of transportation was said to be suffering from 'Railway spine' to describe their new found nervousness. It was known as 'Shell Shock' in World War I and 'Combat Fatigue' in World War II. In 1952 it referred to as 'Stress Response Syndrome' in the DSM I. By the time the DSM II was published SRS was put in with a new category called 'Situational disorders'.
The study of Vietnam War veteran's suffering resulted in a single diagnosis that included many psychiatric symptoms by the time the third edition of the DSM was published in 1980.
Post Traumatic Stress Disorder Today
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May of 2013 has revised PTSD to include exposure to trauma as a necessary element. PTSD is now no longer known as an anxiety disorder but reclassified into a new class of a "trauma and stressor-related disorders"
This means that a true PTSD diagnosis now requires exposure to a traumatic or stressful event.
Diagnostic Criteria (DSM-IV-TR) for Posttraumatic Stress Disorder
Criteria Symptom or description
Criteria A: Trauma (both)
- Traumatic event that involved actual or threatened death, serious injury, or threat to physical integrity
- Intense response of fear, helplessness, or horror
Criteria B: Re-experiencing symptoms (one or more)
- Intrusive recollection of events
- Recurrent distressing dreams of the event.
- Acting or feeling as if the traumatic event were recurring
- Distress at the internal or external reminders of the trauma
- Physiological reaction to internal or external reminders
Criterion C: Persistent avoidance and numbing (three or more)
- Avoidance of thoughts, feelings, or conversations associated with the trauma.
- Avoidance of activities, places, or people that arouse recollections of trauma.
- Failure to recall an important aspect of trauma
- Loss of interest or participation in significant activities.
- Detachment from others.
- Restricted range of affect.
- Lost sense of future.
Criterion D: Hyperarousal (two or more)
- Difficulty falling or staying asleep.
- Irritability or outburst of anger.
- Difficulty concentrating.
- Exaggerated startle response
Criterion E: Duration of disturbance
- Duration of disturbance symptoms is more than one month.
Criterion F: Clinically significant distress or impairment
- Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of function.
The American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC; 2013
What Causes PTSD
According to the American Psychiatric Association, PTSD is caused by experiencing, witnessing, or being confronted with an event that involves serious injury, death, or threat to the physical integrity of an individual, along with an emotional response of helplessness and/or intense fear or horror. There are many factors, personal and psychological and environmental factors that can increase each individual's vulnerability to develop PTSD such as the characteristics of the trauma. The proximity, severity, and duration of the Trauma upon the person should be considered. Also the characteristic of the individual which includes any exposure to trauma in the past, any preexisting and past psychiatric conditions, substance abuse, family history of traumatic events. Any involvement in combat, having been neglected during childhood, along with physical abuse and molestation are usually associated with PTSD in men. Rape, being threatened with a weapon, molestation and physical abuse are commonly associated with PTSD in women. Posttraumatic factors include avoidance, numbing, hyperarousal, and re-experiencing symptoms.
Is it PTSD or something else? According to DSM-IV-TR
Signs and Symptoms
Acute stress disorder
Symptoms lasts for a minimum of 2 days and a maximum of 4 weeks, and occur within 4 weeks of the traumatic event
May occur following a tramuatic event, the main predominant symptoms are a dysporic mood with disturbances in energy and sleep appetite, usually accompanied by loss of interest in pleasurable activities, a dn presence of suicidal ideation and intention
Although similar in regard to the symptoms of fear and avoidance that are cued and triggered by specific objects or situations, re-experiencing is not usually a feature of phobias.
Recurrent, un expected panic attacks not cued or triggered by situations, events or stimuli associated with recall of specific traumatizing events(s)
Generalized anxiety disorder
Symptoms can vary and may include constant worrying or obsession about small or large concerns, restlessness and feeling keyed up or on edge, fatigue difficulty concentrating, irritability, muscle tension or muscle aches, trembling, feeling twitchy, trouble sleeping, sweating, nausea or diarrhea, shorness of breath or rapid heartbeat.Although these symptoms are very similar to PTSD, they do not occur as a result of a traumatic event(s) and are not cued or triggered by them.
Specific stressors lead to the development of variable mood, anxiety, worry, sleep disturbances, predominant feelings of inability to cope, plan ahead, or problems solving. Symptoms severity varies with the stressors' intesity. Symptoms usually subside with the remission of the precipitating stressors and with gaining of coping and problem solving abilities.
Persistent and recurrent feelings of detachment and estrangement from onself (depersonalization disorder.) Gaps in recall are often related to traumatic events (dissociative amnesia). Absence of re-experiencing and hyperarousal symptoms.
Obsessive compulsive disorder
Recurrent intrusive thoughts, which lead to anxiety and are perceived as inappropriate, may be accompanied by compusions, rituals, or activities to counteract the anxiety and not related to a traumatic experience.
Substance abuse or medically induced symptoms
Medical history, symptoms onset and resolution are timely associated with the medical condition(s), and/or the abuse of substances.
Inconsistency in symptom presentation, poor work record, and discrepancies in the capacity for working vs. the ability to participate in recreation and entertainment activities are common. Thre is an exaggeration of functioning level before the traumatic experience and predominant evasiveness.
How do I know if it is PTSD?
Only a primary care provider can diagnose any condition. A primary care provider will be aware that PTSD commonly shares the psychiatric conditions described above and to screen for signs of any co-occurring conditions during a patients initial evaluation. There are laboratory and brain imaging testings that if needed, can be performed.
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