Experiencing trauma can have a long-lasting impact on an individual’s mental health and well being.
Posttraumatic stress disorder is the most common mental disorder that people experience after traumatic events have occurred in their lives.
The diagnostic and statistical manual (fifth edition), often referred to as the DSM-5, is a widely referenced manual that allows mental health professionals to evaluate a patient’s symptoms and decide whether or not they meet the diagnostic criteria for PTSD and other mental disorders.
What is posttraumatic stress disorder?
Posttraumatic stress disorder (PTSD) is a psychiatric disorder featuring extreme psychological distress and disruption to a person’s daily living and occurs in association with traumatic event exposure.
The DSM-5 categorizes posttraumatic stress disorder into four categories:
- Avoidance – of behaviors and thoughts
- Intrusion symptoms
- Changes in arousal
- Adverse changes in mood and thoughts
The above symptoms are related to a traumatic event or a series of traumatic events.
Individuals who develop PTSD may avoid places, objects, people, or situations that remind them of the event.
It’s also common for trauma survivors to avoid thoughts, feelings, and sensations associated with a traumatic event or situation.
Perhaps one of the most difficult PTSD symptoms to manage is the intrusive thoughts and memories associated with a traumatic event. Symptoms include:
- Repeated upsetting dreams or nightmares related to a traumatic event
- Involuntary, recurrent and intrusive disturbing memories of the event
- Intense fear and pervasive distress to cues related to the circumstance that is either internal or external
- Dissociation such as experiencing flashbacks and feeling as though you are reliving the event again
- Profound body responses such as increased heart rate and trembling when reminded of the event
#3. Changes in arousal
Those with post-traumatic stress disorder often feel keyed up or on guard.
Most people who develop PTSD often feel as though danger is imminent, a condition that often gets referred to as hypervigilance.
Symptoms of arousal include:
- Increased or heightened startle response
- Self-destructive or impulsive behavior
- Problems sleeping
- Aggressive or irritable behavior
- Memory issues or difficulty concentrating
#4. Adverse changes in mood or thoughts
Individuals who develop PTSD after traumatic experiences may find themselves in a persistent emotional state of negativity such as fear, shame or anger.
The typical symptoms that feature in this category are:
- Increased self-blame or blaming others for the event thinking that you or someone else caused the tragedy to occur
- Loss of interest in activities and hobbies you once enjoyed
- Developing negative beliefs that you are ”unlovable” or that the world is a ”bad place”.
- Inability to experience positive emotions such as love, joy and happiness
- Feeling isolated and detached from others
Research suggests that there is no explanation for why some people experience psychological trauma and PTSD symptoms after a traumatic event and some don’t.
However, there are risk factors that increase the likelihood of people developing PTSD, such as:
- A lack of social support during and after a traumatic event
- History of mental illness and other anxiety disorders
- Experiences with past trauma
- History of substance abuse
Studies show that other factors such as genetics and gender can determine whether someone develops PTSD symptoms or not.
For example, the literature shows that women are more at risk than men of developing trauma symptoms post-trauma.
How does the DSM iv diagnose PTSD?
There is a set criterion for a person diagnosed with posttraumatic stress disorder. They include:
- The person must have one (or more) intrusion symptoms
- The person must have gotten exposed to a traumatic event
- The person must have one (or more) avoidance symptoms
- The person must have two (or more) symptoms of adverse changes in feelings and mood
- The person must have two (or more) signs of arousal and reactivity
In addition to the above, the individual must also:
- Experience symptoms for longer than one month
- Be unable to relate symptoms to another medical condition such as anxiety disorders or substance abuse.
- Experience symptoms that are significantly distressing and interfere with numerous aspects of a person’s life
Modifications to the DSM-5
The DSM-5 has undergone significant changes in recent years. For example, the removal of PTSD from the section on anxiety disorders and reclassifying the condition under ”trauma and stressor-related disorders”.
For mental health professionals to make an accurate diagnosis with patients, the DSM-5 has become more stringent with its policies and criteria.
These fundamental changes involved:
- Adding different aspects of exposure to the event
- Accurately defining what kind of events are considered traumatic
- Increasing the amount of symptom groups from three to four and classifying them into sub-groups, e.g. avoidance, intrusion etc
- Adding a new section of criteria for children aged six and under
- Altering the wording of some of the symptoms
What are the different PTSD types?
Different PTSD types are dependent on what kind of exposure to trauma a person has endured and the type of trauma experienced.
The psychological effects of trauma have a different impact on everyone. However, many events can trigger trauma reactions in a person, including:
- Natural disasters
- Exposure to life-threatening events or threatened death
- Domestic violence
- Serious injury
- Physical abuse
- Emotional abuse
- Childhood trauma
- Sexual abuse
- Interpersonal violence
- Childhood sexual abuse
The different PTSD types include:
- Complex PTSD: The condition characterizes traumatic events that are chronic and occur in early life. Note: Complex PTSD does not currently get listed in the DSM – 5.
- Dissociative: To meet the criteria for a PTSD diagnosis, somebody must experience symptoms of a subtype disorder (such as dissociative), including depersonalization or derealization.
- Delayed expression: In the past, this type of PTSD was categorized as ”delayed onset”. This type of trauma response typically occurs at least six months following a traumatic event.
Acute stress disorder
Following traumatic events, it is common for people to experience acute stress disorder.
Acute stress disorder is related to PTSD and shares similar features and symptoms.
However, one of the main differences between PTSD and acute stress disorder is the timeline of symptoms and how long they present themselves.
For example, a PTSD diagnosis requires a person’s symptoms to be present for more than a month.
On the other hand, someone with acute stress disorder may have symptoms for a much shorter duration (e.g. from three days to one month).
Plenty of research has been conducted around complex trauma or complex posttraumatic stress disorder (CPTSD), which has distinct features from classical PTSD.
Recent research has produced detailed analysis and data around C-PTSD and the connection between specific personality disorders such as borderline personality disorder.
Trauma specialist Judith Lewis – Herman proposed complex PTSD in 1992, explaining that many patients often get diagnosed with borderline personality disorder when what they are suffering from is chronic trauma.
”Concepts of personality developed in ordinary circumstances are frequently applied to survivors, without an understanding of the deformations of personality which occur under conditions of coercive control.
Thus, patients who suffer from the complex sequelae of chronic trauma risk getting misdiagnosed as having personality disorders. They may be described as ”dependent”, ”masochistic”, or ”self-defeating”.
Earlier concepts of masochism or repetition compulsion might be more usefully supplanted by the concept of a complex traumatic syndrome” ( Judith Lewis – Herman, 1992).
Fortunately, there are many trauma treatments available to the general population who have experienced trauma.
Depending on the traumatic stressors, the type of diagnosis a person receives and the severity of symptoms, treatment gets customized to match the needs of each individual.
Psychotherapy treatments help treat trauma, such as:
- Cognitive-behavioural therapy (CBT)
- Group therapy
- Eye movement desensitization reprocessing (EMDR)
- Exposure therapy
Other therapeutic techniques include:
- Treatment for substance abuse or other addictions
- Support groups and supportive relationships with family members and friends
If you or someone you know is struggling to cope with the effects of trauma, contact one of our specialists who will help.