Posttraumatic stress disorder (PTSD) follows from exposure to events in which a person’s life was threatened, sexual abuse, or a person felt that they were threatened with serious injury. These events can be directly experienced or witnessed occurring to other persons.
The syndrome is defined in the DSM-5 by 20 possible symptoms that are organized under four types of symptoms:
1. Recurrent, involuntary, and intrusive memories of the traumatic event.
2. Distressing dreams or nightmares.
3. Dissociative reactions – flashbacks or freezing episodes.
4. Psychological distress at exposure to reminders about the trauma.
5. Physiological distress at exposure to reminders about the trauma (rapid heart, shaky, sweat, dry throat, short of breath, dizzy).
6. Avoidance of memories, thoughts, or feelings about the trauma.
7. Avoidance of people, places, conversations, activities, objects, or situations that resemble the trauma.
Negative alterations in cognitions and mood symptoms
8. Inability to remember major aspects of the event.
9. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
10. Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame himself/herself or others.
11. Persistent negative emotional states.
12. Diminished interest in usual activities.
13. Feelings of detachment or estrangement from others.
14. Inability to express positive emotions.
Increased arousal symptoms
15. Irritability or angry outbursts.
16. Reckless or self-destructive behavior.
18. Exaggerated startle response
19. Problems with concentration.
20. Sleep disturbance.
How is it Diagnosed/Measured?
Interview with a doctor or counselor. A standardized checklist can be helpful to thoroughly cover all of the symptoms.
For the diagnosis, a patient must have at least one re-experiencing, one avoidance, two negative alteration, and two increased arousal symptoms. The symptoms must persist for at least one month and the patient must also have impairment in functioning.
Severity is best measured with a questionnaire that rates each symptom on a Likert-style range.
Dr. Michael Scheeringa, a world-recognized expert in PTSD, and founder of the Kid Catch Foundation, created a free PTSD checklist, which can be downloaded for free here.
When to Refer/Seek Help?
Research has shown that almost everyone will show some symptoms in the first month after truly life-threatening events. Most people recover naturally within the first month.
Any substantial change in the emotional or behavioral functioning of children that lasts more than one month should trigger a referral for an assessment by a mental health specialist.
For a more detailed handout sheet on what to expect following trauma, click here.
Psychotherapy is the first-line treatment for PTSD.
Medications are not a first-line treatment for PTSD. The FDA has approved two medications for PTSD in adults, but not for pediatric populations. Even in adults, medications are typically not as effective as psychotherapy. Medications can be helpful for specific types of symptoms such as sleep, mood irritability, and situational anxiety.
Link to National Child Traumatic Stress Network
Link to International Society for Traumatic Stress Studies
-Updated January 23, 2019