Posttraumatic Stress Disorder

• Symptoms develop after exposure to a traumatic event

• Exposure to actual of threatened death, serious injury or sexual violence in one (or more) of the
following:

• Direct experience traumatic event

• Witnessing, in person, the event occurring to others

• Learning that the event occurred to close family member of friend

• Experiencing repeated or extreme exposure to aversive details of the event.

• One or more Intrusion symptoms associated with the event, after it occurred:

• Recurrent, involuntary and intrusive distressing memories of event

• Recurrent distressing dreams related to the event

• Dissociated reactions (e.g. Flashbacks) as if event were recurring

• Intense or prolonged psychological distress at exposure to internal or external cues

symbolic or resembling the event

• Marked physiological reactions to cues related to event .

• Persistent avoidance of stimuli associated with the event

• Distressing memories, thoughts or feelings

• External reminders

• Negative alterations in cognitions and mood associated with event (two or more)

• Inability to remember important aspects of event

• Persistent and exaggerated negative beliefs or expectations about self, others or the
world

• Persistent, distorted cognitions about cause or consequences of event

• Persistent negative emotional state

• Markedly diminished interest or participation in significant activities

• Feelings of detachment or estrangement from others

 • Persistent inability to experience positive emotions

• Marked alterations in arousal and reactivity associated with event (two or more):

• Irritable behavior and angry outbursts

• Reckless or self- destructive behavior

• Hypervigilance

• Exaggerated startle response

• Problems with concentration

• Sleep disturbance

Duration: more than 1 month

Causes significant distress or impairment

PTSD for Children (6 years old –below)

• Similar to PTSD for beyond 6 years except for exposure and developmental expressions
of symptoms

• Fear of being separated from parents

• Losing previously- acquired skills

• Sleep problems and nightmares without recognizable content

• Somber, compulsive play in which themes or aspects of the trauma are repeated

• New phobias and anxieties that seem unrelated to the trauma

• Acting out the trauma through play, stories or drawings

• Aches and pain with no apparent cause

• Irritability and aggression

 Risk Factors
• Pretraumatic Factors

• Temperament (childhood emotional problems, prior mental disorders)

• Environment (low SES, low education, lower intelligence, prior trauma, childhood
adversity, cultural characteristics related to coping)

• Gender (female)

• Peritraumatic Factors

• Severity

• Personal injury

• Interpersonal violence

• Posttraumatic Factors

• Temperament (negative appraisals, inappropriate coping, acute stress disorder)

• Environment (adverse life events, other traumatic losses, social support)

Etiology
• Psychological

• Related Symptoms prior to trauma

• Inadequate coping strategies

• Temperament

• Biological

• Reactivity and dampening reactivity: Amygdala; Hippocampus; Prefontal Cortex

• Biochemical: Cortisol

Reference: (Diagnostic and Statistical Manual of Disorders, Fifth Edition , 2016)