the diagnostic criteria and treatments for PTSD

Post-traumatic stress disorder (PTSD) is classified under the rubric of Trauma and Stress related disorders in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The rubric of Trauma and Stress related disorders is itself relatively new, starting only with the DSM-5, with previous editions classifying the disorder as an anxiety disorder (Sascher & Goldbeck, 2016). Unlike anxiety disorders, all disorders classified under the Trauma and Stress umbrella are differentiated by the presence of a precipitating traumatic event (McGraw-Hill Education, 2012). In other words, one of the main diagnostic criteria of PTSD is exposure to a traumatic or stressful event: such as “death, threatened death,” violence or violation: witnessed or directly experienced (National Center for PTSD, n.d.). Military veterans are of course repeatedly exposed to such traumatic events, which is why the prevalence of PTSD is relatively high among this population cohort. In fact, PTSD was once informally described as “shell shock,” (American Psychiatric Association, 2018). When it became apparent that the symptoms of “shell shock” were also common among some victims of rape or child abuse, the concept of PTSD as a psychiatric disorder evolved.
While most people experience at least some type of traumatic event during their lifetime, only ten percent of the population will develop the symptoms of PTSD: an unusual, persistent, and debilitating long-term psychological response to stress. Recent research has revealed that those who do develop PTSD have experienced measurable changes in their neurobiological systems, altering the ability of the person to effectively respond to stressors in the environment (Heim, Schultebrauchs, Marmar, et al., 2018). Many people experience acute symptoms immediately following the traumatic event, but “most individuals are able to cope with the stressor and maintain or regain homeostasis” in both body and mind (Heim, Schultebrauchs, Marmar, et al., 2018, p. 331). Those who do not regain homeostasis may be diagnosed with PTSD if they fulfill the primary diagnostic criteria outlined in the DSM-5. The DSM-5 contains several necessary diagnostic criteria for PTSD. A person who meets some but all of these criteria may not receive a diagnosis for PTSD.
For example, PTSD refers to the manifestation of a cluster of symptoms including at least one of each from several different categories including intrusion symptoms, avoidance symptoms, cognitive and mood symptoms, and alterations in arousal and reactivity (National Center for PTSD, n.d.). Intrusion symptoms refer to nightmares, flashbacks, and other means in which the individual essentially relives the initial traumatic event. The person may have a physiological as well as a psychological response to environmental triggers that are associated that the precipitating trauma. Environmental triggers could be sensory such as sounds, smells, or places. To be diagnosed with PTSD, the individual must exhibit at least one intrusion symptom.
The individual also needs to exhibit at least one avoidance symptom to be diagnosed with PTSD. Avoidance symptoms include behaviors that the individual adopts to avoid experiencing the unpleasant responses to the environmental stimuli that trigger the intrusion symptoms. Substance abuse, for example, could be classified as a means by which to avoid, numb, or push away the thoughts and feelings associated with the trauma. The person might also deliberately avoid people or situations that are reminders of the event, even when those people or situations once gave the person pleasure.
Another key diagnostic criterion is changes to the person’s cognition and/or mood since the precipitating event. To receive the PTSD diagnosis, the person needs to exhibit at least two specific mood or cognitive symptoms including negative affect, feelings of isolation, persistent negative or pessimistic thoughts, and difficulties accessing or processing memories related to the crisis. Finally, the person may exhibit externalized changes to arousal responses since the precipitating event. The changes could be irritability, aggression, increased participation in risky behaviors, self-destructive or destructive behaviors, difficulty sleeping or concentrating, and hypersensitivity to external stimuli (National Center for PTSD, n.d.). Individual differences will determine symptom specificity.
Not only do all the symptomatic diagnostic criteria need to be filled, but also the duration and severity. During assessments for PTSD, the clinician would determine how long the symptoms have been present. Symptoms need to have been present for at least one month, and also must have created serious functional impairments or distress in the person’s life, such as inability to perform at work or a breakdown in the person’s relationships with loved ones. Furthermore, the clinician needs to conduct differential diagnoses to make sure the symptoms of PTSD are not actually traceable to some underlying medical condition or are side-effects of some medication or drugs the person is taking. Recent research also suggests that differential diagnosis should emphasize the presence of flashbacks as a unique feature of PTSD, as flashbacks are not present in those with other clinical conditions with similar symptoms (Sachser & Goldbeck, 2016). Because PTSD symptoms do overlap or concur with the symptoms of other psychiatric disorders including substance abuse disorder and some anxiety and depressive disorders, many people with PTSD also receive comorbid diagnoses.
The symptoms of PTSD can be managed via evidence-based treatment interventions. Psychotherapy and psychopharmacology both offer assistance to people with PTSD. There is no one universal psychotherapeutic model used to manage PTSD symptoms, but cognitive restructuring and exposure therapy have both proven effective (National Institute of Mental Health, 2018). Group therapy can also help the individual develop resilience through social support networks. Likewise, different types of medications may be warranted depending on the person’s symptoms and needs. A combination of therapeutic interventions is most likely to help those suffering from PTSD.






References

American Psychiatric Association (n.d.). What is posttraumatic stress disorder? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Heim, C., Schultebraucks, K., Marmar, C.R., et al. (2018). Neurobiological pathways involved in fear, stress, and PTSD. In Nemeroff, C.B. & Marmar, C. (Eds.) Post-Traumatic Stress Disorder. (p. 331). Oxford University Press.
McGraw-Hill Education (2012). PsychSmart. 2nd Edition. McGraw Hill, Kindle Edition.
National Center for PTSD (n.d.). DSM-5 criteria for PTSD. https://www.brainline.org/article/dsm-5-criteria-ptsd
National Institute of Mental Health (2018). Post-traumatic stress disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Sachser, C., & Goldbeck, L. (2016). Consequences of the Diagnostic Criteria Proposed for the ICD-11 on the Prevalence of PTSD in Children and Adolescents. Journal of Traumatic Stress, 29(2), 120–123. doi:10.1002/jts.22080