Posttraumatic Stress Disorder – A Real and Often Overlooked Injury

It is not unusual for a person to experience some sort of stress reaction, such as: upsetting memories, having trouble sleeping, or feeling on edge after witnessing or experiencing a traumatic event. Often, a person’s initial reaction to trauma meets the criteria for Acute Stress Disorder (“ASD”) immediately after experiencing a traumatic event. An estimated 13 to 21 percent of survivors of car accidents develop acute stress disorder and between 20 and 50 percent of survivors of assault, rape or mass shootings develop it.[1]

However, if the person’s reaction doesn’t go away over time or disrupt a person’s life, that person may have developed Posttraumatic Stress Disorder (“PTSD”).[2] PTSD is a mental condition that some people develop after experiencing or witnessing a life-threatening event.[3] ASD is different from PTSD in that symptoms of ASD are restricted to a duration of three (3) days to one (1) month.[4] About half of people with ASD go on to have PTSD.

A diagnosis of PTSD is made by using the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 5^thEdition, commonly referred to as the DSM-5. Those criteria are as follows:

Criterion A: Stressor (one required) – the person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

1. Direct exposure to traumatic event;
2. Witnessing the traumatic event as it occurred to others;
3. Learning the traumatic event occurred to a relative or close friend;
4. Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics).

Criterion B: Intrusion Symptoms (one required) – the traumatic event is persistently re-experienced in the following way(s):

1. Unwanted upsetting memories;
2. Nightmares;
3. Flashbacks;
4. Emotional distress after to exposure to traumatic reminders;
5. Physical reactivity after exposure to traumatic reminders.

Criterion C: Avoidance (one required) – avoidance of trauma-related stimuli after the trauma in the following way(s):

1. Trauma-related thoughts or feelings;
2. Trauma-related reminders

Criterion D: Negative Alterations in Cognition and Mood (two required) – negative thoughts or feelings that began or worsened after the trauma in the following ways:

1. Inability to recall key features of the trauma;
2. Overly negative thoughts and assumptions about oneself or the world;
3. Exaggerated blame of self or others for causing the trauma;
4. Negative affect;
5. Decreased interest in activities;
6. Feeling isolated; Difficulty experiencing positive affect.

Criterion E: Alteration in Arousal and Reactivity (two required) – trauma-related arousal and reactivity that began or worsened after the trauma in the following ways:

1. Irritability or aggression;
2. Risky or aggression;
3. Risky or destructive behavior;
4. Hyper vigilance;
5. Heightened startled reaction;
6. Difficulty concentrating;
7. Difficulty sleeping.

Criterion F: Duration (required) – symptoms last for more than one (1) month.

Criterion G: Functional Significance (required) – symptoms create distress or functional impairment (e.g, social, occupational).

Criterion H: Exclusion (required) – symptoms are not due to medication, substance abuse or other illness.

Symptoms of PTSD often begin within the first three (3) months after the traumatic event, although there may be a delay of several months or even years before the criteria for the diagnosis are met.[5]PTSD affects approximately 3.5 percent of U.S. adults, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime.[6]The duration of PTSD symptoms varies with complete recovery within three (3) months occurring in approximately 50% of adults, while others remain symptomatic for more than twelve (12) months and sometimes for more than fifty (50) years.[7]PTSD is associated with high levels of social, occupational and physical disability, as well as considerable economic costs and high levels of medical utilization.[8]

If you or someone you know has experienced a traumatic event and meets the criteria listed above, it is important for them to get the treatment they need. Generally, the earlier a person gets treatment, the better the likely outcome.