Posttraumatic Stress Disorder Essay

it is estimated that more than 6% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Center for PTSD, 2010). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to substance abuse issues and even physical ailments. For this Discussion, as you examine the Thompson Family Case Study in this week’s Learning Resources, consider how you might assess and treat clients presenting with PTSD.Posttraumatic Stress Disorder Essay

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Post on or before Day 3 an explanation of your observations of the client William in Thompson Family Case Study, including behaviors that align to the PTSD criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.

Post-Traumatic Stress Disorder (PTSD) is a trauma and stress-related disorder that may develop after exposure to an event or ordeal in which death or severe physical harm occurred or was threatened. People who suffer from the disorder include military troops, rescue workers, and survivors of shootings, bombings, violence, and rape. Family members of victims can develop the disorder as well through vicarious trauma.Posttraumatic Stress Disorder Essay

PTSD affects about 8 million American adults and can occur at any age, including childhood. Women are more likely to develop the disorder than men, and there is some evidence that it may run in families. PTSD is frequently accompanied by depression, substance use disorder, and anxiety disorders. When other conditions are appropriately diagnosed and treated, the likelihood of successful treatment increases.

When symptoms develop immediately after exposure and persist for up to a month, the condition may be called acute stress disorder. PTSD is diagnosed when the stress symptoms following exposure have persisted for over a month. Delayed expression of PTSD can occur if symptoms arise six months or more following the onset of trauma.

Roughly 30 percent of Vietnam veterans developed PTSD. The disorder also has been detected in as many as 10 percent of Gulf War (Desert Storm) veterans, about 6 percent to 11 percent of veterans of the Afghanistan war, and about 12 percent to 20 percent of veterans of the Iraq war. For veterans, factors related to combat may further increase the risk for PTSD and other mental health problems. These include the veteran’s role in the war, the politics around the war, where it’s fought, and the type of enemy faced. Another cause of PTSD in the military is military sexual trauma (MST) or sexual harassment or assault that occurs in the military. MST happens to men and women and can occur during peacetime, training, or war. Among veterans using VA health care, about 23 percent of women reported sexual assault while in the military, 55 percent of women and 38 percent of men have experienced sexual harassment when in the military.Posttraumatic Stress Disorder Essay

The Healing Power of Telling Your Trauma Story
5 Myths About PTSD
What Does It Take to Survive Emotionally After a Disaster?
How to Talk to a Vet
Symptoms
Many people with PTSD tend to re-experience aspects of the traumatic event, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event and similarities in person, place, or circumstance can trigger symptoms. People with PTSD experience intrusive memories or flashbacks, emotional numbness, sleep disturbances, anxiety, intense guilt, sadness, irritability, outbursts of anger, and dissociative experiences. Many people with PTSD may try to avoid situations that remind them of the ordeal. When symptoms last more than one month, a diagnosis of PTSD may be relevant.Posttraumatic Stress Disorder Essay

Symptoms associated with reliving the traumatic event:

Having bad dreams, or distressing memories about the event
Behaving or feeling as if the event were actually happening all over again (known as flashbacks)
Dissociative reactions or loss of awareness of present surroundings
Experiencing intense emotions when reminded of the event
Having intense physical sensations when reminded of the event (heart pounds or misses a beat, sweating, difficulty breathing, feeling faint, feeling a loss of control)
Symptoms related to avoidance of reminders of the traumatic event:

Avoiding thoughts, conversations, or feelings about the event
Avoiding people, activities, or places associated with the event
Symptoms related to negative changes in thought or mood:

Having difficulty remembering an important part of the original trauma
Feeling numb or detached from things
Lack of interest in social activities
Inability to experience positive moods
Pessimism about the future
Arousal and reactivity symptoms:

Sleeping Difficulties including trouble falling or staying asleep
Irritability and outbursts of anger
Difficulty concentrating
Feeling easily startled
Excess Awareness (hypervigilance)Posttraumatic Stress Disorder Essay
Other symptoms related to depersonalization (feeling like an observer to one’s body and thoughts/feelings) or derealization (experiencing unreality of surroundings) may also exist for some individuals.

Causes
The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves. People who have suffered childhood abuse or other previous traumatic experiences are likely to develop the disorder, sometimes months or years after the trauma. Temperamental variables such as externalizing behaviors or other anxiety issues may also increase risk. Other environmental risk factors include family dysfunction, childhood adversity, cultural variables, and family history of psychiatric illness. The greater the magnitude of the trauma, the greater the risk for PTSD—witnessing atrocities, severe personal injury, perpetrating violence. Inappropriate coping mechanisms, lack of social support, family instability, or financial stress may further worsen the outcome.Posttraumatic Stress Disorder Essay

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Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these resilience factors are present before the trauma and others become important during and after a traumatic event. Resilience factors that may reduce the risk of PTSD include seeking out support from other people, such as mental health professionals, friends and family, finding a support group after a traumatic event, feeling good about one’s own actions in the face of danger, having a coping strategy, and being able to act and respond effectively despite feeling fear.

Treatment
Treatment for PTSD typically begins with a detailed evaluation and development of a treatment plan that meets the unique needs of the survivor. The main treatments for people with PTSD are psychotherapy, medications, or both. Due to differences in experience and consequence of the trauma, treatment varies and is tailored to the symptoms and needs of the individual. Treatment by a mental health care provider who is experienced with PTSD allows people to lead more balanced and functional lives. Some people with PTSD may need to try different treatments to see what works for their symptoms.Posttraumatic Stress Disorder Essay

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, treatment may include helping find safety. PTSD-specific-treatment can begin only when the survivor is safely removed from the crisis situation. Individuals who experience other symptoms of panic disorder, depression, substance use disorder, and those who feel suicidal, may need treatment to focus on those issues as well.

Other strategies for treatment include:

Educating trauma survivors and their families about risks related to PTSD, how PTSD affects survivors and their loved ones, and other problems commonly associated with PTSD symptoms. Understanding that PTSD is a medically recognized disorder is essential for effective treatment.
Exposure to the event via imagery allows the survivor to re-experience the event in a safe, controlled environment. A professional can carefully examine reactions and beliefs in relation to that event.
Examining and resolving strong feelings such as shame, anger, or guilt, which are common among survivors of trauma.
Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without avoiding them or becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but new coping skills can make them more manageable.
Medications Posttraumatic Stress Disorder Essay

The U.S. Food and Drug Administration (FDA) has approved two medications to treat adults with PTSD, sertraline (Zoloft) and paroxetine (Paxil) which are selective serotonin reuptake inhibitors (SSRIs). Both of these medications are antidepressants, which are also used to treat depression. They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb. Using medications jointly with therapy or prior to starting therapy may make treatment more effective. If an antidepressant is prescribed, it may need to be taken for several days or weeks before providing significant improvement. It is important to not get discouraged and prematurely stop taking medications before they’ve had a chance to work. An adjustment in dosage or a switch to another SSRI may help address these issues. It is important to work collaboratively with your doctor.Posttraumatic Stress Disorder Essay

Sometimes people taking these medications experience side effects. The effects can be frustrating, but they usually go away. However, medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately. The most common side effects of antidepressants like sertraline and paroxetine are:

Headaches, which usually go away within a few days.
Nausea, which usually goes away within a few days.
Sleeplessness or drowsiness, which may occur during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.
Agitation or feeling jittery.
Sexual problems, which can affect both men and women, including reduced sex drive, and problems having and enjoying sex.
There are other types of medications that doctors may also prescribe, such as the following: Benzodiazepines may be given to help people relax and sleep more easily, although there is potential for developing dependence. Antipsychotics may be prescribed to people who experience more severe agitation, suspiciousness, or paranoia. Other antidepressants like fluoxetine (Prozac) and citalopram (Celexa) can help people with PTSD feel less tense or sad. For people with PTSD who also have other anxiety disorders or depression, antidepressants may be useful in reducing symptoms of these co-occurring illnesses. The potential side effects related to the use of these medications involves a dialogue with your provider.Posttraumatic Stress Disorder Essay

Similarly, antidepressant medications called tricyclics are given at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. They are as effective as the SSRIs, but many physicians and patients prefer newer drugs because the tricyclics sometimes cause dizziness, dry mouth, drowsiness, and weight gain. Mood stabilizers such as lamotrigine and divalproex sodium may also be helping in treating symptoms.

Psychotherapy

Therapy is well-regarded in the treatment of PTSD. It involves talking with a mental health professional to work through the experience and its impact on the individual. Psychotherapy can occur one on one or in a group format. Therapy for PTSD usually lasts until the individual has learned to manage and cope with their experience and is able to be more functional.Posttraumatic Stress Disorder Essay

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

Cognitive behavioral therapy, or CBT, has been found to be quite effective in treating PTSD. There are several parts to CBT, including:

Exposure therapy: This therapy helps people be more aware of their experience. It may expose them to the memory of the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
Cognitive restructuring: This therapy helps people make sense of their memories and experiences. Sometimes people remember the event differently than how it actually happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.Posttraumatic Stress Disorder Essay
Stress inoculation training: This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety when confronting anxiety-provoking situations. Like cognitive restructuring, this treatment helps people look at their experiences in a healthy way.
There are also other types of treatment that can help people with PTSD and a client may want to discuss with their therapist about therapy options and treatment focus that may include:

Learning about trauma and its effects
Using relaxation and anger management skills
Improving sleep, diet, and exercise habits
Identifying and dealing with guilt, shame, and other feelings about the event
Focusing on our reactions to PTSD symptoms—for example, therapy helps people visit places and people that are reminders of the trauma
Eye movement desensitization and reprocessing (EMDR) is a treatment for traumatic memories that involves elements of exposure therapy and cognitive behavioral therapy, combined with techniques (sounds, eye movements, hand taps) that create an alteration of attention. There is some evidence that the therapeutic element unique to EMDR, attentional alteration, may be helpful in accessing and processing traumatic material.Posttraumatic Stress Disorder Essay

Brief psychodynamic psychotherapy focuses on the emotional conflicts caused by the traumatic event. This therapy helps a person understand how the past affects the way they feel now. Through the retelling of the traumatic event to a calm and empathic counselor, the survivor achieves a greater sense of self-esteem, develops effective ways of thinking and coping, and more successfully deals with the intense emotions that emerge during therapy. The therapist helps the survivor identify current life situations that set off traumatic memories and worsen PTSD symptoms.

Group treatment is an ideal therapeutic setting because trauma survivors are able to seek help and support while sharing traumatic material in a safe environment. As group members achieve greater understanding and resolution of their trauma, they often feel more confident and able to trust themselves and others. As they discuss and share trauma-related shame, guilt, fear, rage, doubt, and self-condemnation, they learn to focus on the present rather than the past. Telling one’s story and directly facing the grief, guilt, and anxiety related to the trauma enables many survivors to cope with their symptoms, memories, and lives.Posttraumatic Stress Disorder Essay

Family therapy is a type of counseling that involves the whole family, as PTSD can affect the entire family. One’s children or partner may not understand why the person gets angry sometimes, or why they are under so much stress. They may feel scared, guilty, or even angry about the condition. In family therapy, a therapist helps the patient and family communicate, maintain good relationships and cope with tough emotions. Each person can express his or her fears and concerns. It’s important to be honest about those feelings and to listen to others. The patient can talk about PTSD symptoms, triggers, and important parts of treatment and recovery. By doing this, the person’s family will be better prepared to help them.

Today we are here to figure out why is it that past events are the triggers that cause Post Traumatic Stress Disorder. Post-Traumatic Stress Disorder is an anxiety disorder that some people get after seeing or undergoing a dangerous event. There are various symptoms that begin to show or actions that can give a clear answer whether one may be diagnosed with this disorder. One of the many problems is that no age range is safe from suffering PTSD. One must ask themselves what set of events happened at that time to cause this disaster to occur and how did these events change the lives of these occupants’ forever. By the end of this paper, we will have our results and understanding why this affects many people. Posttraumatic Stress Disorder Essay
Luckily, I didn’t get injured and my car had minor damage. To get to the point, this accident didn’t cause me a massive amount of stress when I am driving. What it did was constantly make me look at my rear view mirror when I stopped the car at a red light. It makes me remember how fast the other guy was going and as you know objects can be farther or closer then they appear. Telling us that the car can be close but look far or vice-versa and to me it’ll feel as though the car is right behind me. An instant accident can cause years of damage psychologically. In the same way, military combat also known as shell shock can cause the same affect to the soldiers that protect our country with their lives. Military combat is a strenuous twenty-four hour job, which requires one to constantly be aware of their surroundings and of any threat that appears.

Post-traumatic Stress Disorder (PTSD) is a persistent and sometimes crippling condition
precipitated by psychologically overwhelming experience. It develops in a significant
proportion of individuals exposed to trauma, and untreated, can continue for years. Its
symptoms can affect every life domain – physiological, psychological, occupational, and
social.
Post-trauma stress reactions have been recognized throughout history. They are
described in classical Greek literature and in the early literature of scientific medicine,Posttraumatic Stress Disorder Essay
but it was first diagnostically defined in modern times in the 1980 American Psychiatric
Association Diagnostic and Statistical Manual. The surge of scientific and clinical
interest in the condition over the past two decades has been largely due to awareness of
problems associated with returning Vietnam combat veterans and advocacy by the
feminist movement on behalf of rape victims. PTSD has not been documented in other
groups including abused children, victims of crimes, accidents, and natural disasters.
Not all trauma survivors develop PTSD. About 20% of crime victims, across type of
crime, will meet diagnostic criteria. The rates are substantially higher for some crimes.
For example, more than half of rape victims are afflicted. However, most crime victims
do have some initial PTSD symptoms that subside over time.
DIAGNOSTIC CRITERIA
The diagnosis of PTSD, as described in the DSM-IV(APA, 1994), requires the presence
of definite traumatic experience and certain symptoms. A person must A1) have been
subjected to an experience that threatened loss of life or identity or serious injury, and
A2) have reacted to that event with intense emotion – horror, fear, or helplessness; B) reexperience the event in dreams, flashbacks, vivid intrusive thoughts, or emotional and
physiological reactions to reminders of the event; C) show three or more avoidant and/or
numbing features associated with the event; D) exhibit symptoms of arousal. (See Table
I for a listing of symptoms.) Additional diagnostic requirements include that at least a
month must have elapsed since the index event and that the person have some functional
disability – inability to function normally at work, in their families, or within their social
networks.Posttraumatic Stress Disorder Essay
The current DSM-IV criteria rely heavily on items that require verbal descriptions of
internal experiences and states. There is growing consensus that more developmentally
sensitive criteria are needed for children due to their limited ability to express their
subjective experiences. The current modifications in the DSM-IV symptom criteria for
children are presented in bolded text in Table i.
Some experts have proposed a variant known as Complex PTSD. In this condition some
individuals may have more pervasive disturbances, including identity problems,
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difficulties in affect regulation. Complex PTSD is not an officially sanctioned diagnosis
at this time.

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BIOLOGIC CHARACTERISTICS
There is increasing evidence that PTSD is associated with biological alterations or
abnormalities. Individuals with PTSD have an atypical stress response. Instead of
producing increases in cortisol, a stress related hormone, the usual hypothalamic-pituitary
axis mechanisms are disrupted and result in lower than expected levels of the hormone.
It is possible to induce PTSD symptoms in diagnosed individuals with injection of
relatively benign chemical stimuli. Decreased brain volume or volume of specific brain
structures have been documented in some adults and children with PTSD. The biologic
correlates have not yet been fully explored, nor are the implications for intervention
established.
TABLE 1: POST-TRAUMATIC STRESS DISORDER
DSM IV DIAGNOSTIC CRITERIA
CRITERION A:CRITERIAN B: CRITERIAN C: CRITERION D:CRITERION E & F
Trauma Re-experiencing Numbing and Arousal Additional
(Both) Symptoms Avoidant Symptoms Diagnostic
(1+) (3+) (2+) Requirements
1. Traumatic 1. Intrusive 1. Avoids 1. Insomnia Duration of
and thoughts of thoughts/ 2. Irritability Sxs:>one month
2. Intense trauma or feelings 3. Difficulty and
response; may repetitive 2. Avoids concentrating Disturbance
be expressed posttraumatic activities/ 4. Hyper- causes clinic-
by disorganized play people vigilance ally significant
or agitated 2. Recurrent 3. Failure of 5. Exaggerated distress or im-
behavior nightmares recall of the startle pairment in
(includes trauma response social, occu-
those w/o 4. Loss of in- pational, or
recognizable terest in sig- other important
content) nificant activ- areas of function
3. Flashbacks 5. Detachment from
or trauma- others
specific 6. Restricted affect
reenactment 7. Lost sense of the
4. Distress at future
reminders of
the trauma
5. Physiological
reaction to
reminders
KEY: BOLDED TEXT = MODIFICATIONS IN DAGNOSTIC CRITERIA FOR CHILDREN
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POPULATIONS AT RISK
According to general population surveys conducted over the past five years, PTSD is
among the most common psychiatric conditions in American society. Younger adults
and adolescents seem somewhat more susceptible than older adults. Less is known about
the very young, who respond to trauma in less typical ways, but post-traumatic
syndromes are believed to occur and to exert profound influences on development and
later emotional health.Posttraumatic Stress Disorder Essay
One representative national sample of women revealed a life-time prevalence of PTSD of
12.3% and rate of current PTSD of 4.6% (Resnick, et al., 1993). The authors estimated
that 11.8 million adult women in the U.S. would have experienced PTSD at some time
during their lives, and 4.4 currently have PTSD. This study found a significantly higher
rate of PTSD among crime versus non-crime victims (25.8% vs. 9.4%). Another general
population study (Kessler, et.al, 1995) reported a lifetime prevalence of 7.8% (5% of
men; 10.4% of women).
There is a single nationally representative survey of adolescents that assessed for PTSD
diagnosis (Kilpatrick & Saunders 1997). This study found that 8.1% of the adolescents
surveyed met DSM-IV criteria for PTSD during their lifetime and 4.9% currently met
criteria. They estimated that 1.8 million adolescents in the U.S. meet the DSM-IV
criteria at some point during their lifetime and 1.1 million currently suffer from PTSD.
The survey also showed that the rates of lifetime and current PTSD increase significantly
with age; by age 17, the rates of lifetime and current PTSD increased to 13.1% and 8.4%,
respectively.
People vary in susceptibility to PTSD. Genetic factors may play a significant role in
susceptibility. Women develop PTSD at about twice the rate as men, even for the same
crimes. Individuals with a prior trauma history or multiple traumas are at increased risk.
A premorbid psychiatric history also increases the likelihood of developing the disorder.
It may be that people who have fewer supports and limited inter-personal coping skills
are more likely to develop PTSD. Studies of concentration camp survivors and prisoners
of war, however, suggest that even given sufficient trauma intensity and duration most of
those who are exposed develop PTSD.Posttraumatic Stress Disorder Essay
A positive relationship has been found between trauma intensity and the likelihood of
PTSD. people who have been injured or perceived the event as life threatening are more
likely to develop PTSD than those with less severe trauma. Human caused traumatic
events such as assaults and murder have a more powerful impact than accidents and
natural disasters. Among crime victims, individuals who have suffered more brutal
trauma have higher frequencies of PTSD – torture (54%), rape (49%); badly beaten
(32%), and other sexual assault (24%). Dissociation during the trauma, peritraumatic
dissociation, is associated with risk for PTSD.
As previously mentioned, most crime victims experience PTSD symptoms although they
do not develop the disorder. Re-experiencing and arousal symptoms are almost universal
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in the immediate aftermath. Similar relationships between the nature and severity of
trauma and PTSD symptoms as for those with the disorder have been found in adults and
adolescents (Boney-McCoy & Finkelhor, 1995; Norris & Kaniasty, 1994).
Cognitive distortions and faulty attributions are commonly associated with PTSD.
Maladaptive cognitions may be specifically related to the trauma per se. Guilt and shame
about aspects of the experience or the fact of being victimized are the most common.
Other cognitive impacts reflect alterations in basic assumptions about self, others, and the
world.
CLINICAL COURSE
Once established PTSD tends to persist. About half of those who develop PTSD
spontaneously recover over the two years following the event. After that time symptoms
may wax and wane in intensity or different clusters may be more prominent at a
particular time, but they usually do not dissipate entirely. Anniversaries and life crises
may precipitate setbacks.
CO-MORBIDITY – ADULTS
Individuals with PTSD often suffer from other psychiatric conditions; nearly 80% of
women and 90% of men with lifetime history of PTSD develop at least one other disorder
(Kessler et al., 1995). Depression accompanies PTSD almost half of the time (Davidson
& Froa, 1993). Substance abuse develops frequently among men, whereas women are
more prone to psychologically determined physical complaints. Anxiety disorders (i.e.
generalized affective disorder, panic disorder, simple phobia, social phobia, agoraphobia)
are common among both sexes. Co-morbidity with PTSD would be expected for some of
these disorders due to the overlap in symptom criteria; for example, criteria C and D
PTSD symptoms (e.g., irritability, hypervigilance, exaggerated startle) overlap with
symptoms that characterize generalized anxiety disorder and criterion B5 (physiological
reactivity) could overlap with panic disorder, simple phobia, and/or social phobia (see
Table 1).
CO-MORBIDITY – CHILDREN
Children with PTSD also have fairly high rates of psychiatric co-morbidity (ACAP,
1998). Depression and other anxiety disorders (e.g. Posttraumatic Stress Disorder Essay agoraphobia, separation anxiety, and
generalized anxiety disorder) are quite common in children who have been traumatized.
Other children may respond to trauma by displaying externalizing symptoms-or
behavioral problems. Disruptive behavior disorders, like Conduct Disorder and
Oppositional-Defiant Disorder, are not uncommon among children with PTSD, and are
most often associated with physical abuse, exposure to violence, or coercive family
dynamics. Young children often present anxiety-related responses manifested by
hyperactivity, distractibility, and impulsivity which are hallmarks of Attention-Deficit
Disorder (ADHD). However, some authors have suggested that ADHD in traumatized
children may actually be misdiagnosed PTSD.
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2. ACUTE STRESS DISRODER
OVERVIEW
Many victims of crime suffer from a variety of short-term stress and dissociative
symptoms during or immediately after the trauma. Although these reactions do not
necessarily lead to PTSD, they can cause significant emotional and psychological distress
as well as functional impairment. The diagnosis of Acute Stress Disorder (ASD) was
recently incorporated into the DSM-IV in order to recognize and classify the
psychological reactions and sequelae that occur within one month after an acute stressor
(Briere, 1997).
DIAGNOSTIC CRITERIA
The defining features of ASD are the development of dissociative and post-traumatic
stress symptoms that occur within one month of the traumatic event (APA, 1994). The
diagnostic criteria of ASD similar to PTSD regarding the stressors involved and the
symptoms experienced, except that only one symptom each of the –re-experiencing,
avoidant, and arousal clusters are required for an ASD diagnosis (see Table 2), The
individual must have at least three of the following dissociative symptoms during or after
experiencing the traumatic event: (1) a subjective sense of numbing, detachment, or
absence of emotional responsiveness, (2) a reduction in awareness of his or her
surroundings (e.g., “being in a daze”), (30 de-realization, (4) depersonalization and/or (5)
dissociative amnesia (i.e. inability to recall an important aspect of the trauma)(APA,
1994).
TABLE 2: ACUTE STRESS DISORDER
DSM IV DIAGNOSTIC CRITERIA
Trauma Dissociative Sx Re-experiencing Sx Anxiety or Additional
(Both) (3+) (at least 1) Arousal Diagnostic
Symptoms Requirements
(at least 1)
1. Traumatic 1. Subjective 1. Intrusive 1. Insomnia Duration of Sxs:
event and sense of thoughts of trauma 2. Irritability 2 days to 4 weeks
2. Intense numbing, 2. Nightmares 3. Difficulty AND
response detachment, 3. Flashbacks concentrating Disturbance causes
or absence 4. Distress at reminders 4. Hypervig- clinically significant
of emotional of the trauma ilence distress, or impairment
responsive- 5. Physiological reaction 5. Exaggerated in social, occupational,
ness to reminders startle or other important
2. A reduction in Avoidance Symptoms response areas of function.
awareness of (at least 1) 6. Motor AND
surroundings Avoids trauma re- restlessness The disturbance is not
3. De-realization minders: due to the direct
4. De-personali- 1. Thoughts, feelings physiological effects
zation 2. Conversations, from substance abuse
5. Dissociative activities of drug or use of
amnesia 3. People, places a medication
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DURATION
This disturbance lasts for a minimum of two days and does not persist beyond four
weeks; when symptoms persist beyond 1 month, a diagnosis of PTSD may be appropriate
if the full criteria are met. ASD symptoms and reactions must also occur within four
weeks of the traumatic event, whereas PTSD diagnosis requires that at least one month
has elapsed since the traumatic index event.Posttraumatic Stress Disorder Essay
3. ASSESSMENT AND MANAGEMENT OF PTSD ADULTS
DIAGNOSTIC CRITERIA
Please read the Diagnostic Criteria Section of these guidelines
ASSESSMENT
There are a number of excellent assessment guides that have been recently published to
help mental health professionals through this process (See Briere, 1997; Carlson, 1997;
Wilson & Keane, 1996; Stamm, 1996; van der Kolk et. al., 1996). The following
recommendations for PTSD assessment are based on this current literature.
1. PLANNING AND PREPARING FOR ASSESSMENT
It is important to provide a neutral or positive, and safe setting for the evaluation.
Clinicians should be aware of the potential re-traumatizing effects of assessment
interviews and the use of probing techniques. The assessment setting or clinician
characteristics may resemble those of the offender or the traumatic scene and
reactive post-traumatic stress. Recalling and describing the traumatic event
during the assessment may also trigger intense feelings of distress and a desire to
escape or avoid the situation. Clinicians should anticipate and be prepared to
respond to distress reactions. For example, a clinician may choose not to
administer a particular psychological test or delay having the victim provide a
detailed description of the traumatic event until they are more stable.
Clinicians must strive to maintain the victim’s state of well being and avoid
potential harm. It follows that the pacing, tone, and preparation for the interview
should be carefully considered and adjusted as necessary. The developmental and
comprehension level of the client must also be taken into account. Alerting
victims beforehand that they may experience assessment-related distress, as well
as providing assurance and grounding afterwards may be helpful (e.g. reminding
them that they are safe; explaining that their reactions are reasonable due to the
circumstances) (Briere, 1997). Posttraumatic Stress Disorder Essay

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