Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation.
For a doctor or medical professional to be able to make a diagnosis, he has strict diagnostic criteria, which has to be met. He will do this by asking you a series of questions or listening to talk about an event or events in your life in which you feel significantly changed your behaviour. One recognized standard for assessing PTSD is the World Health Organization’s ICD-10.
It was thought that PTSD could not be a result of “normal” events such as bereavement, business failure, interpersonal conflict, marital disharmony, working for the emergency services, etc, and most of the research on PTSD had been undertaken with people who had suffered a threat to life (e.g. combat veterans, especially from Vietnam, victims of accident, disaster, and acts of violence). It is now recognized that PTSD can result from many types of shocking experience.
A lot of the research, which has been undertaken into PTSD, has been carried out in America, especially after the Vietnam War.
The diagnostic criteria for PTSD are as follows:
A. The person experiences a traumatic event in which both of the following were present:
- The person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
- The person’s response involved intense fear, helplessness, or horror.
B. The traumatic event is persistently re-experienced in any of the following ways:
- Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;
- Recurrent distressing dreams of the event;
- Acting or feeling as if the traumatic event were recurring (e.g. reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated);
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event;
- Physiological reactivity on 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:
- Efforts to avoid thoughts, feelings or conversations associated with the trauma;
- Efforts to avoid activities, places or people that arouse recollections of this trauma;
- Inability to recall an important aspect of the trauma;
- Markedly diminished interest or participation in significant activities;
- Feeling of detachment or estrangement from others;
- Restricted range of affect (e.g. unable to have loving feelings);
- Sense of a 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) as indicated by at least two of the following:
- Difficulty falling or staying asleep;
- Irritability or outbursts of anger;
- Difficulty concentrating;
- Hyper vigilance;
- Exaggerated startle response.
E. The symptoms on Criteria B, C and D last for more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
The focus of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include:
Repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (e.g. bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in airplane disasters, etc)Repeated involvement in dealing with serious crime, e.g. where violence has been used and especially where children are hurtBreaking news of bereavement caused by accident or violence, especially if children are involvedRepeated violations such as in verbal abuse, physical abuse and sexual abuseRegular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc
All of these can be substituted in a military environment, not just as described indicating only emergency services (e.g. Police, Fire or Ambulance).
Where the symptoms are the result of a series of events, the term Prolonged Duress Stress Disorder (PDSD) may be more appropriate. Whilst PDSD is not yet an official diagnosis in ICD-10, it is often used in preference to other terms such as “rolling PTSD” and “cumulative stress”.