Post-Traumatic Stress Disorder Diagnosis

  • Diagnosis

    Post-traumatic stress disorder (PTSD) is a stage of severe anxiety in reaction to an extremely traumatic event. People suffering from post-traumatic stress disorder (PTSD; historically called "shell shock" or "battle fatigue") can have feelings of intense fear, helplessness, or horror in response to a past traumatic event.

    While it is normal for anxiety to occur right after a traumatic event, PTSD develops later--sometimes weeks or months after the event. Symptoms of anxiety that begin within four weeks of after a traumatic event and resolve within four weeks--for example, having nightmares for a week after being in a car accident--are classified as "acute stress disorder," and are considered to be normal. PTSD, on the other hand, develops weeks to months after the traumatic event, and symptoms can last longer.

    The cause for PTSD is not known, but psychological, genetic, physical, and social factors may contribute to it. Between 5% and 10% of Americans will develop PTSD at some time in their lives. Women are more susceptible to PTSD than are men. PTSD is treated with both drug therapy and counseling.

    PTSD can develop after you experience a traumatic event. Personal traumatic experiences that can lead to PTSD include military combat, torture, violent personal assault (sexual assault, rape, physical attack, robbery, mugging), being kidnapped, being taken hostage, experiencing natural or man-made disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.

    You may also develop PTSD after witnessing a traumatic event, even if you were not directly involved. Witnessing a serious injury or unnatural death of another person due to violent assault, or unexpectedly witnessing a dead body or body parts can lead to PTSD. PTSD can also develop after learning about an especially traumatic event. For example, learning of a violent assault, serious accident or serious injury, or unexpected death of a close friend or family member, or learning that one’s child has a life-threatening disease, can all lead to PTSD.

    Repeated and invasive memories of the traumatic event are the most common symptom of PTSD Table 01. You may have recurrent and intrusive recollections of the event, or recurrent distressing dreams during which the event is replayed. In rare circumstances, you may experience a state of disconnection from self, time, or external circumstances (dissociative state) that lasts from just a few seconds to several hours or days. Portions of the traumatic event may be re-lived during these periods. You may feel and behave as though you are experiencing the event in that moment. Intense psychological stress or physiological reactivity often occur when you are exposed to events resembling or symbolizing an aspect of the traumatic event. For example, if you were attacked in an elevator, entering an elevator may trigger intense stress. Anniversaries of the event may also trigger stressful memories.

    Additional symptoms that may occur with PTSD include nightmares, outbursts of anger, chronic physical problems such as headache or irritable bowel, a preoccupation with possible unknown threats, and an inability to relate to others.

    Table 1.  Symptoms of PTSD

    Repeated dreams or recurrent flashbacks of the eventa
    Traumatic dreams, sleeping problems
    Psychological numbing
    Intense distress if exposed to anything resembling the event
    Outbursts of anger
    A preoccupation with possible unknown threats
    Chronic physical symptoms such as pain, headache, irritable bowel
    Efforts to avoid people or activities that may arouse recollection of the trauma
    Feelings of guilt
    No sense of a future

    a Children may not directly remember the event, but may recall a single image or express their fear by repeatedly playacting an event or action. Children's dreams, while frightening, may have no specific content.

    Symptoms of PTSD can be acute, chronic, or delayed. Acute symptoms last less than three months; chronic symptoms last longer. Delayed symptoms start at least six months after the traumatic event.

    Not everyone who lives through an intense trauma will develop PTSD. Though it is not known why some people are more susceptible to PTSD, certain correlates have been observed. Women are more likely to develop PTSD than are men. Individuals with a history of depression and anxiety conditions are at greater risk of developing PTSD. Persons with a history of childhood abuse are also at increased risk. Family history of psychiatric illness also predicts increased risk of developing PTSD. Keep in mind that these factors alone do not cause PTSD; exposure to extreme trauma causes it.

    The severity, duration, and closeness of your exposure to the trauma are the most important factors affecting your likelihood of developing PTSD. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence whether or not you develop PTSD. However, you can develop PTSD even if you don’t have any predisposing conditions; particularly if the traumatic event was especially extreme.

    Recent immigrants may be at increased risk for PTSD. Recent immigrants from areas of considerable civil unrest or social conflict may have increased rates of PTSD. Due to their vulnerable political status, they may be especially reluctant to discuss experiences of torture and trauma. Other groups at risk of exposure to extreme trauma are military personnel exposed to combat, victims of natural disasters, and those involved in rescue missions.

    Your doctor will discuss your symptoms with you to determine if you could have PTSD. If your doctor finds no medical cause for your symptoms during a physical examination, he or she will ask you a series of questions to determine if you have PTSD. For example, your doctor will ask you if you have experienced or witnessed an event that involved actual or threatened death or serious injury. The doctor will also ask if you have distressing dreams, if you experience recurring flashbacks of a traumatic event, or if you experience difficulty sleeping, outbursts of anger, difficulty paying attention, a loss of interest in activities or the future, or a sense of unreality. If your primary care physician suspects PTSD, he or she may refer you to a psychologist or psychiatrist for further evaluation and treatment.

    Counseling after a traumatic event may help reduce your chances of developing PTSD. The earlier counseling begins after the traumatic event, the better your chances of lessening or eliminating symptoms of PTSD.

  • Prevention and Screening

    Counseling after a traumatic event may help reduce your chances of developing PTSD. The earlier counseling begins after the traumatic event, the better your chances of lessening or eliminating symptoms of PTSD.

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