PTSD: The Diagnosis

Today, the accepted criteria for a diagnosis of PTSD are:

A.  The person has been exposed to a traumatic event in which both of the following have been present:

  1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
  2. The person's response involved intense fear, helplessness or horror.  Note: in children, it may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

  1. Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions.  Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  2. Recurrent distressing dreams of the event.  Note: in children, there may be frightening dreams without recognizable content.
  3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).  Note: in children, trauma-specific reenactment may occur.
  4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C.  Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

  1. Efforts to avoid thoughts, feelings or conversations associated with the trauma.
  2. Efforts to avoid activities, places or people that arouse recollections of the trauma.
  3. Inability to recall an important aspect of the trauma.
  4. Markedly diminished interest or participation in significant activities.
  5. Feelings of detachment or estrangement from others.
  6. Restricted range of affect (e.g., unable to have loving feelings).
  7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span).

D.  Persistent symptoms of increased arousal (not present before the trauma), indicated by at least two of the following:

  1. Difficulty falling or staying asleep.
  2. Irritability or outbursts of anger.
  3. Difficulty concentrating.
  4. Hyper-vigilance.
  5. Exaggerated startle response

 E.  Duration of the disturbance (symptoms in B, C, and D) is more than one month.

F.  The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

The veterans featured in Soldier’s Heart exhibit a wide array of the symptoms of posttraumatic stress disorder.  As you walk with them through their life experiences, PTSD will become more than a sterile enumeration of causes and symptoms and will change forever the way you view this debilitating disorder.