Comorbidity (notably alcohol abuse and depression) is common - around 44% of women and 59% of men with chronic PTSD will meet criteria for at least 3 other psychiatric disorders. There is a delayed category in which the onset of symptoms is at least 6 months post-trauma. The DSM-IV requires that symptoms have been present for at least one month, highlighting the fact that such a symptom constellation may be common in the first few weeks. The final cluster of symptoms is those of persistently increased arousal. The numbing symptoms are proposed as being central to the diagnosis of PTSD, differentiating it from an uncomplicated distress response. In more severe cases, there is a pervasive numbing of general responsiveness to a variety of current life experiences. In an attempt to prevent the occurrence of these distressing re-experiencing phenomena, the person is likely to avoid any reminders of the trauma. Individuals with PTSD remain so captured by the memory of past horror that they have difficulty paying attention to the present. This is in some conflict with the notion of the stress having the primary role in the diagnosis.Ī second group of diagnostic criteria relates to re-experiencing the trauma. This latter feature is a matter of controversy because the variability of perception between people exposed to the same event can introduce a person's premorbid stress reactivity into the aetiological equation. DSM-IV (summarised in Table 1) emphasises a physical threat, as well as the presence of subjective distress. The symptoms commonly vary in intensity over time and occasionally present years after the trauma.Īn essential requirement for a diagnosis of PTSD is experience of a traumatic event. 2, 3 Other life stressors, and environmental triggers reminiscent of the trauma, play a central role in determining the severity of current symptoms. 2 Of these, around 60% will recover, even without the benefit of treatment. Research suggests that around 10% of women and 5% of men will meet criteria for PTSD at some stage in their lives. In a minority of cases, there is a progressive recruitment of symptoms and disability in the period following traumatic exposure. There is a return of a sense of safety and the soothing of disturbed patterns of reactivity. In the majority of people, symptoms progressively resolve over the first few months. Only when symptoms are severe, or last too long, is the response considered pathological. Psychological distress is part of a normal human response to overwhelming experiences. The definition of specific diagnostic criteria has prompted considerable empirical research and theoretical debate. The term post-traumatic stress disorder (PTSD) emphasised that a single disorder accounted for the psychopathological consequences of all traumatic events such as combat, rape and life-threatening accidents. It was not until 1980, however, with the advent of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), 1 that the disorder was formally recognised. Historically, terms such as shell shock, battle fatigue and compensation neurosis have been used to describe the psychological effects of trauma. References appear as far back as Homer's Iliad. The history of reactions to trauma goes back for many hundreds of years. Referral for intensive treatment should be made in more severe cases. Several strategies may be adopted by primary health care providers to assist patients with both acute and chronic forms of the disorder. The possible existence of the disorder can be ascertained with a few simple questions. In its more serious forms, it is a chronic and disabling psychiatric disorder associated with high comorbidity and impairment of functioning. It is a common anxiety disorder in Australia with a 12-month prevalence of 3.3%. Post-traumatic stress disorder (PTSD) has been the focus of considerable attention, and some controversy, since it was formally recognised in 1980.
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