Post-traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder which results from the experience of a terrifying trauma considered to be outside the range of normal human experience (American Psychiatric Association, 2000).

A trauma is defined as an emotionally overwhelming experience (APA, 2000). PTSD usually follows an extreme situation such as a traumatic event involving warfare, rape, hostage situations, natural disaster, or involvement in a serious accident or assault.

The person may personally experience such a situation or they may witness it happening to someone else. It can also result from long term chronic exposure to a severe stressor, for example soldiers who endure ongoing battles (the disorder was originally known as ‘shell shock’).

The three main components of post-traumatic stress disorder

1. Persistent re-experiencing of the traumatic event, in the form of images, flashbacks and nightmares
2. Avoidance of cues that act as reminders of the event and intense arousal and anxiety on exposure to these cues (including anniversaries)
3. Physiological arousal such difficulty sleeping, irritability or poor concentration (Andrews et al., 1996).

For a diagnosis of PTSD, the disturbance needs to have lasted longer than four weeks following the catastrophic event. It is possible there may be a delayed onset, with anxiety symptoms arising after a period of six months or more. Acute Stress Disorder is initially diagnosed if the event has caused impairment that lasts for a minimum of two days and a maximum of four weeks.

The onset of the distress must also occur within four weeks of the traumatic event for this diagnosis (American Psychiatric Association, 2000). PTSD can be divided as Acute PTSD (diagnosed 1 month after the event occurs) and Chronic PTSD (which is diagnosed 3 months after the traumatic event). Chronic PTSD is usually associated with more prominent avoidant behaviors (Barlow & Durand, 2009). Delayed onset PTSD indicates that at least 6 months has elapsed between the traumatic event and the onset of the symptoms.

Short screening measure for post-traumatic stress disorder

1. Do you avoid being reminded of the experience by staying away from certain places, people or activities?
2. Have you lost interest in activities that were once important or enjoyable?
3. Have you begun to feel more distant or isolated from other people?
4. Do you find it hard to feel love or affection for other people?
5. Have you begun to feel that there is no point in planning for the future?
6. Have you had more trouble than usual falling or staying asleep?
7. Do you become jumpy or easily startled by ordinary noise or movements?

(Australian Centre for Posttraumatic Mental Health, 2007)

If a person says “yes” to four or more of these questions, a PTSD diagnosis is likely. Research into this scale has established that, among individuals exposed to trauma, 71% of people who say yes to 4 or more items have a diagnosis of PTSD and 98% of people who say yes to less than 4 do not have the diagnosis.

PTSD rarely exists as a separate disorder. Depression and other anxiety disorders, as well as substance abuse, are frequently experienced alongside PTSD – an important consideration in the sequencing of treatment. For example, in treating PTSD with depression, PTSD symptoms are usually treated first as depression generally improves as symptoms of PTSD reduce. However, treating PTSD with substance abuse should have a focus on both conditions as they both maintain each other.

Adjustment Disorder is also a common response to acute stress. It appears to occur on a continuum of anxiety, with PTSD being at the more extreme end. Adjustment disorder is classified as a maladaptive reaction to an identifiable stressor that occurs within three months of the onset of the stressor. Emotional symptoms (for example, sadness, anger, anxiety, worry, tension and a sense of being overwhelmed) and behavioral symptoms (for example, fighting, reckless driving, avoiding family and friends, skipping school and vandalism) are common. Distress does not last longer than six months after the stressor is over.

Source: Anxiety Disorders CE Course