About PTSD



Education About Posttraumatic Stress Disorder

    This handout contains educational material about Posttraumatic Stress Disorder drawn from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV: American Psychiatric Association, 1994).  The DSM-IV is the book professionals use to diagnose emotional problems.

What Is Posttraumatic Stress Disorder?

    Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to a traumatic event.  

    What is a traumatic event?  It is a serious threat to your physical integrity, or to the physical integrity of someone you love.  The DSM-IV lists some possible examples:  human-made traumas (military combat, rape, violent assault, childhood sexual or physical abuse, domestic battering, being kidnapped, being a victim of political terrorism; torture); natural disasters (violent storms, earthquakes, floods); severe accidents (such as car accidents or severe injuries); or close, personal encounters with violence or death (being diagnosed with a life-threatening illness, witnessing the death or severe injury of another person, unexpectedly viewing a dead body, learning about the illness or death of a loved one).  The person's response to the trauma involves intense fear, helplessness, or horror.  

    The severity of the trauma, how long it lasts, and how close to you it happens are the most important factors determining whether a person develops the disorder.     

The Symptoms of Posttraumatic Stress

    There are three types of characteristic symptoms:  

    1) Persistent reexperiencing of the trauma;

     2) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness;

    3) Persistent symptoms of increased arousal.  

If you have been diagnosed with Posttraumatic Stress Disorder, you are experiencing all three types of symptoms.  We will discuss each one in turn.

    Persistent reexperiencing of the trauma.  There are a number of ways that you might reexperience the trauma:  you might keep remembering the trauma; you might keep having intrusive images, thoughts, or bodily sensations of the trauma; you might have recurrent nightmares; you might have disssociative episodes in which you seem to relive the trauma -- in which you suddenly begin acting and feeling as though it is happening again; or you might have flashbacks upon awakening from sleep, during episodes of substance abuse, or upon exposure to something that reminds you of the trauma.  

    Persistence avoidance of stimuli associated with the trauma and numbing of general responsiveness.  You try to avoid thinking, feeling, or talking about the trauma.  You try to avoid people or places that arouse memories of the trauma.  Most likely this phobic avoidance is interfering with your intimate relationships, social life, and work performance.  You may be unable to remember some important aspect of the trauma.    

    You are experiencing "psychic numbing."  You feel less interested in your life, and you are participating less in the significant activities of your life.  You feel detached and estranged from other people.  Your ability to feel emotions is constricted -- for example, you might be unable to feel love or tenderness.  You have a sense of a foreshortened future, and no longer expect to have a normal life.

    Persistent symptoms of increased arousal.  Since the trauma, you have been experiencing symptoms of anxiety or increased arousal.  You might have one or more of the following symptoms:  panic attacks; difficulty falling or staying asleep; irritability or outbursts of anger; difficulty concentrating or completing tasks; hypervigilance to threats in your enviroment; and exaggerated startle response.

    To qualify for the diagnosis, you must have had these symptoms for at least one month; and the symptoms must cause you significant distress or significant impairment in your social or work functioning.  Your symptoms might have begun immediately following the trauma, or they may have been delayed for months or even years.

Associated Features

    Individuals with Posttraumatic Stress Disorder often experience "survivor guilt" -- painful guilt feelings about surviving when others did not survive, or about the things they did in order to survive.  

    The DSM-IV notes that the disorder may be especially severe or long lasting when the event is of human design (for example, violent crime, childhood sexual or physical abuse, rape, domestic battering, being a victim of political terror, torture).  These "human-made" traumas are associated with the following symptoms:

    1.  Difficulty controlling your emotions;

    2.  Self-destructive and impulsive behavior;

    3.  Dissociative symptoms;

    4.  Physical problems;

    5.  Feelings of ineffectiveness;

    6.  Feelings of shame, despair, or hopelessness;

    7.  Feeling damaged;

    8.  Loss of previous beliefs;

    9.  Hostility;

    10.  Social Withdrawal

    11.  Feeling constantly threatened;

    12.  Difficulty relating to others.   

    Individuals with Posttraumatic Stress Disorder are more likely to experience anxiety symptoms and phobias, fear and avoidance of social situations, depression, somatic problems, and substance abuse.