The diagnostic criteria for Post-Traumatic Stress Disorder are defined in DSM-IV as follows:
- The person experiences a traumatic event in which both of the following
- The person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
- The person's response involved intense fear, helplessness, or horror.
- The traumatic event is persistently re-experienced in any of the following
- Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;
- Recurrent distressing dreams of the event;
- Acting or feeling as if the traumatic event were recurring (eg reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated);
- Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;
- Physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event.
- Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of:
- Efforts to avoid thoughts, feelings or conversations associated with the trauma;
- Efforts to avoid activities, places or people that arouse recollections of this trauma;
- Inability to recall an important aspect of the trauma;
- Markedly diminished interest or participation in significant activities;
- Feeling of detachment or estrangement from others;
- Restricted range of affect (eg unable to have loving feelings);
- Sense of a foreshortened future (eg does not expect to have a career, marriage, children or a normal life span).
- Persistent symptoms of increased arousal (not present before the trauma)
as indicated by at least two of the following:
- Difficulty falling or staying asleep;
- Irritability or outbursts of anger;
- Difficulty concentrating;
- Exaggerated startle response.
- The symptoms on Criteria B, C and D last for more than one month.
- The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
The focus of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include:
- Repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (eg bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in aeroplane disasters, etc)
- Repeated involvement in dealing with serious crime, eg where violence has been used and especially where children are hurt
- Breaking news of bereavement caused by accident or violence, especially if children are involved
- Repeated violations such as in verbal abuse, physical abuse, emotional abuse and sexual abuse
- Regular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc
Where the symptoms are the result of a series of events, the term Complex PTSD (formerly referred to unofficially as Prolonged Duress Stress Disorder or PDSD) may be more appropriate. Whilst Complex PTSD is not yet an official diagnosis in DSM-IV or ICD-10, it is often used in preference to other terms such as "rolling PTSD", "PDSD", and "cumulative stress". See the National Center for PTSD fact page on Complex PTSD