Post Traumatic Stress Disorder

[ Diagnostic and Statistical Manual - Fourth Revision ]
copyright 1994 by the American Psychiatric Association.
309.81 Posttraumatic Stress Disorder:

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was con-fronted 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

(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

DEFINITIONS TO SERVE DISCUSSION:

A SYNDROME:

is an array of commonly presented symptoms exhibited within a group of persons related to each other by an event or a situation or a circumstance of life which they have experienced. Section A above is the relationship. Section B is the syndrome.

STRESS:

is that anxious driving feeling we all have when we are being challenged to do something or to endure something. We may or may not want to act or endure and the compulsion to act or to endure may come from within ourselves or beyond.

STRESS:

can be perceived as good (like going to a wedding, a business trip, getting ready for the big game) or it can be perceived as bad (getting called up by the boss, facing another rejection as you walk across the dance floor, going to the funeral).

Notes:

• STRESS accumulates !!
• SIMILAR STRESSES bundle !!!
• TRAUMATIC: will be a word to represent that moment when the amount of stress or the power of stress has overwhelmed a person.
• OVERWHELMED: is when a person cannot process even one more bit of information. (tilt, short circuit, blown fuse)
• INFORMATION: is all of that stream of input we get from the five physical senses plus the input from conscience, thoughts, feelings, and the impellation of emotions.
• EMOTION: solely for the purpose of being able to talk about it; I see emotion as the merger of thoughts and feelings. At our ease, we can ruminate thoughts and let feelings run over us. When the two are merged, emotion impells us toward a specific act or goal. We can choose whether or not to respond to the impellation. Until we decide, emotion is yet another stressor.
• CONSCIENCE: is the judge we all have inside of us somewhere. It provides us with the input of judgment when making decisions and when acting to effect those decisions.
• THOUGHTS: are the seemingly random words and phrases enunciated by the little voice inside our heads. Thought is when we make a focused and deliberative use of those words.
• FEELINGS: are the seemingly random sensations that come to us without words. Feeling is our interpretation of those sensations.
• PROCESS: is what we do when we: choose to accept the input, study it, learn from it, talk it through, talk it out, immerse ourselves in it, sleep on it, factor it all out, sift it through, resolve the factors, resolve the experience, categorize it, shelf the lessons for later use and let go of what we have no use for. While the five physical senses are processed, in large part, automatically; thoughts, feelings, conscience, and emotions require deliberate action. It can sometimes take years of hammering before all the factors of a single event become droplets in a stream of life.
• I: is the part of me that uses the word I. It is the part of me that receives and processes all the information described above and then makes use of the results. I cannot point to the part of me that uses the word I but it seems to work well enough.