The symptoms of PTSD typically start soon after a stressful event, though they can be delayed up to six months. After a traumatic event, those presenting with symptoms of post-traumatic stress with impacts on their daily lives would be diagnosed with acute stress disorder within 30 days after the event.
The DSM-V definition of PTSD stipulates that the symptoms must last for more than a month and the condition has caused significant personal distress, affecting daily functioning. The intensity of the symptoms will also vary from time to time, and may worsen if the person experiences stress from other aspects in life or encounters reminders of the traumatic event. The main symptoms of PTSD can be categorised into the following:
- Intrusion: Those suffering from PTSD will experience intrusive thoughts, such as inadvertently recalling the traumatic memory or even flashbacks. These flashbacks can be very vivid as if one is re-living the experience. This could take place at night as well, leading to recurring nightmares.
- Avoidance: As a result of such thoughts, patients may actively try to avoid any place, object, situation or event that may lead them to recall the traumatic event, for example deliberately walking away from the location of the trauma. They may also try to suppress the memory and not talk about the event.
- Changes in arousal: Those with PTSD are described to be ‘hyper-aroused’ whereby a minor trigger can lead to a big response. Patients often appear to be frightened or exhibit a startled response. They may also seem to be ‘always-on-guard’, anxious or irritable, with problems falling asleep or maintaining their concentration.
- Changes in mood and negative thoughts: As a result of the trauma, some patients develop low mood or even feel ‘numb’. They may exhibit a loss of interest in previously pleasurable activities and feel detached from their family and friends. They may also blame themselves and develop a feeling of worthlessness or hopelessness towards the future. Some people develop concurrent depression, substance abuse or various other bodily discomforts.
In 15-30% of cases, especially children, those suffering from PTSD might experience dissociative symptoms. There is a temporary clouding of one’s consciousness, memory, sense of identity and awareness of the self and environment.⁶⋅⁷
There is also a feeling that one is detached from oneself or that the external world is strange or unreal.
In the assessment for PTSD, clinicians would ask for a detailed history regarding the trauma event and the associated symptoms. They may also ask for information on any ongoing litigation processes, as such processes tend to be rather stressful. Some clinicians might use a self-reported measure, PCL-5, for purposes of screening and monitoring of the severity of symptoms over time.⁸
[⁶]Tsai, J., Armour, C., Southwick, S.M. and Pietrzak, R.H., 2015. Dissociative subtype of DSM-5 posttraumatic stress disorder in US veterans. Journal of Psychiatric Research, 66, pp.67-74.
[⁷]Choi, K.R., Seng, J.S., Briggs, E.C., Munro-Kramer, M.L., Graham-Bermann, S.A., Lee, R.C. and Ford, J.D., 2017. The dissociative subtype of posttraumatic stress disorder (PTSD) among adolescents: co-occurring PTSD, depersonalization/derealization, and other dissociation symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 56(12), pp.1062-1072.
[⁸]Blevins, C.A., Weathers, F.W., Davis, M.T., Witte, T.K. and Domino, J.L., 2015. The posttraumatic stress disorder checklist for DSM‐5 (PCL‐5): Development and initial psychometric evaluation. Journal of traumatic stress, 28(6), pp.489-498.
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