differentiates it from adjustment disorder by the extremity of the motivating stressor and from acute stress disorder in its duration. PTSD is the result of a specific traumatic event, whether experienced directly or occurring to an individual close to the patient. PTSD describes the way in which the patient responds to the trauma; an extreme or violent event does not necessarily always trigger a PTSD response in every person.
The triggering event must meet two criteria to begin a diagnosis. First, it must involve "actual or threatened death or serious injury, or a threat to the physical integrity of self or others," and, second, it must result in "intense fear, helplessness, or horror" on the part of the individual (DSM-IV, 1994, pp. 427-428). The event must be traumatic in and of itself, and it must then be perceived as being traumatic by the person it affects.
The symptoms provoked by this perception must them meet three general criteria, which can be expressed in a number of ways: a persistent reexperiencing of the trauma, a persistent avoidance of associated stimuli, and increased arousal. Reliving the experience can take one of a number of forms, including flashbacks, nightmares, and intense reactions to situations that resemble some aspect of the event. Avoidance can take many forms and can include a sense of having no future. Arousal can interfere with sleep or be expressed through hypervigilance or a heightened startle response.
These criteria must be present for more than a month before diagnosis can be made, and they must produce significant distress or impairment of the individual's ability to function. If symptoms last less than three months, the diagnosis is acute PTSD; if they persist, the diagnosis is chronic PTSD. Finally, the onset of PTSD may be delayed, with symptoms appearing long after the trauma has been experienced.
While PTSD subjects may appear to be depressed, Carol A. Glod and her ...