The DSM-IV criteria for identifying PTSD require that symptoms must be active for more than one month after the trauma and associated with a decline in social, occupational or other important areas of functioning. The three broad symptom clusters can be summarized as follows:
1. Persistent Re-experiencing
A person experiences one or more of the following:
- recurrent nightmares or flashbacks;
- recurrent images or memories of the event—these images or memories often occur without actively thinking about the event;
- intense distress of reminders of the trauma; and/or
- physical reactions to triggers that symbolize or resemble the event.
2. Avoidant/Numbness Responses
A person experiences three or more of the following:
- efforts to avoid feelings or triggers associated with the trauma;
- avoidance of activities, places or people that remind the person of the trauma;
- inability to recall an important aspect of the trauma;
- markedly diminished interest in activities;
- feelings of detachment or estrangement from others;
- restricted range of feelings; and/or
- difficulty thinking about the long-term future—sometimes this expresses itself by a failure to plan for the future or taking risks because the person does not fully believe or consider the possibility that they will be alive for a normal lifespan.
3. Increased Arousal
A person experiences two or more of the following:
- difficulty falling asleep or staying asleep;
- outbursts of anger/irritability;
- difficulty concentrating;
- increased vigilance that may be maladaptive; and/ or
- exaggerated startle response
Patterns of Trauma Response
There are various ways in which PTSD can be exhibited:
Acute Stress Disorder is diagnosed when responses to a traumatic event occur and last for less than a month. For many people, these acute symptoms resolve over time, often with the help of a support system or treatment.
PTSD is identified when disabling symptoms persist for months or years after the traumatic event(s). These symptoms interfere with daily functioning and meet specific diagnostic criteria.
Acute PTSD is diagnosed when an individual has symptoms for less than three months.
Chronic PTSD is diagnosed when someone has symptoms for more than three months.
Delayed-onset PTSD appears months—sometimes more than year—after the initial trauma. In many cases, the individual may have had some symptoms before, just not enough to meet the diagnostic criteria. Many people with delayed-onset PTSD demonstrate dissociation to suppress their reactions and avoid thoughts of the event. Numbing and/or avoiding symptoms are associated with a worse prognosis in the long run for many people.