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Diagnosing Post Traumatic Stress Disorder (PTSD)
Post traumatic Stress Disorder (PTSD) is an anxiety disorder that follows exposure to an extreme traumatic stressor (Corcoran, 2006). The diagnostic criteria for PTSD are extensive and precise. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) highlights six necessary components with numerous possible variations of symptomatology.
Firstly, the person must have been exposed to a traumatic event in which they experienced, witnessed or were confronted with an actual threat of death or serious injury to themselves or others. Their response to this exposure must have involved intense fear, helplessness or horror (APA, 2000). Both the exposure to actual or threatened harm and an intense emotional reaction must be present in order for a PTSD diagnosis. Secondly, the traumatic event must be persistently re-experienced which can be done in several ways including recurrent and intrusive recollections, haunting dreams of the event, acting or feeling as if reliving the event, and intense psychological distress. This would include flashbacks, a racing heart, and sweating.
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Further PTSD Diagnostic Criteria
Diagnostic criteria of PTSD must include persistent avoidance of that which is associated with the trauma and an apparent numbing of response. The third criterion includes the avoidance of thoughts, feelings, and conversations associated with the trauma. Activities, places, and people that trigger recollection of the trauma are consequently also avoided. Hindered recollection of the trauma, disinterest or lack of participation in significant, once enjoyed activities, isolation from others, inability to express feelings, and an impending sense of doom or a foreshortened future are all ways that the third criterion may manifest (APA, 2000).
The diagnostic criteria of PTSD require that at least three of the hindrances listed above must be occurring. The National Institute of Mental Health said that feelings of strong guilt, depression or worry are also avoidance symptoms experienced in PTSD. However, as previously mentioned, a person experiencing PTSD may not outwardly express the intense emotions that they are grappling with.
The fourth criterion is persistent symptoms of increased arousal that were not present before the trauma. This must include at least two of the following: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance or exaggerated startle response (APA, 2000). According to the National Institute of Mental Health, hyperarousal symptoms are typically constant when resulting from PTSD.
The final criterion specifies the presentation of a PTSD disturbance. The DSM-IV-TR states that the disturbance must last more than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Daily and basic areas of functioning are also critically impaired. A person experiencing PTSD may alter their routine in order to avoid sequences and environments associated with the traumatic encounter.
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American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Corcoran, J. & Walsh, J. (2006). Clinical assessment and diagnosis in social work practice. New York: Oxford University Press.
National Institute of Mental Health. Post-traumatic Stress Disorder (PTSD). U. S. Department of Health and Human Services. (http://www.nimh.nih.gov)