Post-Traumatic Stress Disorder

Prevalence

• In the United States:

  1. Projected lifetime risk for PTSD using DSM-IV criteria at age 75 years is 8.7%.

  2. Twelve-month prevalence among U.S. adults is about 3.5%.

• Lower estimates are seen in Europe and most Asian, African, and Latin American countries, clustering around 0.5%-1.0%.

• Rates of PTSD are higher among veterans and others whose vocation increases the risk of traumatic exposure (e.g., police, firefighters, emergency medical personnel).

• Highest rates (ranging from one-third to more than one half of those exposed) are found among :

  1. Survivors of rape;

  2. Military combat and captivity;

  3. Ethnically or politically motivated internment;

  4. Genocide.

Symptoms

The following criteria apply to adults, adolescents, and children older than 6 years.

• Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

  1. Direct experience.

  2. Witnessing, in person, the event(s) as it occurred to others.

  3. Learning that the traumatic event(s) occurred to a close family member or close friend.

  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).

• Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

  2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s).

  3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.

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

  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

• Persistent avoidance of stimuli associated with the traumatic event(s) like memories, thoughts, feelings, external reminders...

• Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred.

  1. Inability to remember an important aspect of the traumatic event(s).

  2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.

  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

  4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

  5. Markedly diminished interest or participation in significant activities.

  6. Feelings of detachment or estrangement from others.

  7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

• Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred.

  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.

  2. Reckless or self-destructive behavior.

  3. Hypervigilance.

  4. Exaggerated startle response.

  5. Problems with concentration.

  6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

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