DSM IV
DSM IV
What is DSM IV
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition
Diagnostic Features
The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to:
an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury
other threat to one's physical integrity
witnessing an event that involves death or injury
a threat to the physical integrity of another person
learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member
The person's response to the event must involve:
intense fear
helplessness
horror. In children the response must involve disorganized or agitated behaviour.
The characteristic symptoms resulting from the exposure to the extreme trauma include:
persistent reexperiencing of the traumatic event
persistent avoidance of stimuli associated with the trauma
numbing of general responsiveness
persistent symptoms of increased arousal
The full symptom picture must be present for more than 1 month, and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Traumatic events that are experienced directly include, but are not limited to:
military combat
violent personal assault (sexual assault, physical attack, robbery, mugging)
being kidnapped
being taken hostage
terrorist attack
torture
incarceration as a prisoner of war or in a concentration camp
natural or manmade disaster
severe accidents
being diagnosed with a life-threatening illness
Witnessed events include, but are not limited to:
observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts.
events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease.
The traumatic event can be reexperienced in various ways or show itself as:
the person has recurrent and intrusive recollections of the event, or recurrent distressing dreams during which the event is replayed.
the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment.
Intense psychological distress, or physiological reactivity often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event)
stimuli associated with the trauma are persistently avoided.
the person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event
to avoid activities, situation, or people who arouse recollections of it This avoidance of reminders may include amnesia for an important aspect of the traumatic event
diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event.
the individual may complain of having markedly diminished interest or participation in previously enjoyed activities
feeling detached or estranged from other people
having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality)
the individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span)
the individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma.
diffiiculty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived
hypervigilance
exaggerated startle response
irritability or outbursts of anger
difficulty concentrating or completing tasks
Specifiers
The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder:
Acute: the duration of symptoms is less than 3 months.
Chronic: the symptoms last 3 months or longer.
With Delayed Onset: This indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.