Posttraumatic stress disorder
Posttraumatic stress disorder refers to a persistent psychological disturbance that occurs following a traumatic event. This disorder can follow almost any distressing event, including a natural or manmade disaster, physical or sexual abuse, or an assault or a rape.
Psychological trauma accompanies the physical trauma and involves intense fear and feelings of helplessness and loss of control. Posttraumatic stress disorder can be acute, chronic, or delayed, occuring months or years later after the trauma. When the precipitating event is of human design, the disorder is more severe and more persistent. Onset can occur at any age, even during childhood.
Causes
Posttraumatic stress disorder occurs in response to an extremely distressing event, including a serious threat of harm to the patient or his family, such as war, abuse, violent crime, or natural disaster. It may be triggered by sudden destruction of his home or community by a bombing, fire, flood, tornado, earthquake, or similar disaster. It may also occur after the patient witnesses the death or serious injury of another person by torture, in a death camp, by natural disaster, or by a motor vehicle or airplane crash.
Preexisting psychopathology can predispose some patients to this disorder, but anyone can develop it, especially if the stressor is extreme.
Signs and symptoms
The psychosocial history of a patient with posttraumatic stress disorder may reveal early life experiences, interpersonal factors, military experiences, or other incidents that suggest the precipitating event. Typically, the patient may report that his symptoms began immediately or soon after the trauma, although they may not develop until months or years later. In such a case, avoidance symptoms usually have been present during the latency period.
Diagnosing posttraumatic stress disorder
The diagnosis of posttraumatic stress disorder is made when the patient’s signs and symptoms meet the following criteria documented in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision.
The person was exposed to a traumatic event in which both of the following occurred:
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 (in children, the response may be expressed by disorganized or agitated behavior).
The person persistently reexperiences the traumatic event in at least one of the following ways:
recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
recurrent distressing dreams of the event
acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative episodes that occur even when awakening or intoxicated)
intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
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