Posttraumatic Stress Disorder

(PTSD)
 Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may
occur in people who have experienced or witnessed a traumatic event such
as a natural disaster, a serious accident, a terrorist act, war/combat, or rape
or who have been threatened with death, sexual violence or serious injury.
Criteria in DSM 5

A. Exposure to actual or threatened death, serious injury,

or sexual violence in one (or more) of the following
ways:

•Traumatic event

•Witnessing the trauma

•Learning that a relative or close friend was exposed to a

trauma

•Events occurred to a close family member

•Repeated or extreme exposure to traumatic events

B. Presence of one (or more) of the following intrusion
symptoms associated with the
traumatic event(s), beginning after the traumatic event(s)
occurred:

•Recurrent, involuntary, and intrusive distressing memories

of the traumatic event

•Recurrent distressing dreams

•Dissociative reactions

•Intense or prolonged psychological distress at exposure to

internal or external cues

•Marked physiological reactions to internal or external cues

that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the
traumatic event(s), beginning after the traumatic event(s)
occurred, as evidenced by one or both of the following:

•Avoidance of or efforts to avoid distressing memories,

thoughts, or feelings about or closely associated with the
traumatic event

•Avoidance of or efforts to avoid external reminders that

arouse distressing memories, thoughts, or feelings about or
closely associated with the traumatic event
D. Negative alterations in cognitions and mood associated
with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more)
of the following:

•Inability to remember an important aspect of the traumatic

event

•Persistent and exaggerated negative beliefs or expectations

about oneself, others,
or the world

•Persistent, distorted cognitions about the cause or

consequences of the traumatic
event that lead the individual to blame himself/herself or
others
•Persistent negative emotional state

•Markedly diminished interest or participation in significant

activities.

•Feelings of detachment or estrangement from others.

•Persistent inability to experience positive emotions

E. Marked alterations in arousal and reactivity associated
with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more)
of the following:

•Irritable behavior and angry outbursts (with little or no

provocation) typically expressed as verbal or physical
aggression toward people or objects.

•Reckless or self-destructive behavior.

•Hypervigilance.

•Exaggerated startle response.

•Problems with concentration.

•Sleep disturbance
E. Marked alterations in arousal and reactivity associated
with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more)
of the following:

•Irritable behavior and angry outbursts (with little or no

provocation) typically expressed as verbal or physical
aggression toward people or objects.

•Reckless or self-destructive behavior.

•Hypervigilance.

•Exaggerated startle response.

•Problems with concentration.

•Sleep disturbance
F. Duration of the disturbance (Criteria B, C, D, and E) is
more than 1 month.

G. The disturbance causes clinically significant distress or

impairment in social, occupational, or other important areas
of functioning.

H. The disturbance is not attributable to the physiological

effects of a substance (e.g., medication, alcohol) or another
medical condition.

Specify whether:
With dissociative symptoms: The individual’s symptoms
meet the criteria for posttraumatic stress disorder, and in
addition, in response to the stressor, the individual
experiences persistent or recurrent symptoms of either of the
following:
•Depersonalization: Persistent or recurrent experiences of
feeling detached from, and as if one were an outside observer
of, one’s mental processes or body

•Dereaiization: Persistent or recurrent experiences of

unreality of surroundings

Note: To use this subtype, the dissociative symptoms must

not be attributable to the
physiological effects of a substance or another medical
condition.
 
Specify if:
With delayed expression: If the full diagnostic criteria are not
met until at least 6 months after the event.
Incidence
•The lifetime prevalence of PTSD ranges from 6.1 to 9.2
percent in national samples of the general adult population in
the United States and Canada, with one-year prevalence rates
of 3.5 to 4.7 percent.

•82.7 percent were exposed to severe and potentially

traumatic events, and 8.3 percent of the trauma-exposed
respondents were diagnosed with lifetime PTSD.

•65 percent reported a history of exposure to severe,

potentially traumatic events; 12 percent went on to develop
PTSD
•PTSD cases in the Philippines whenever there are natural
calamities like the eruption of Mt. Pinatubo in 1991 and
when Typhoon Yolanda ravaged the country in 2013

•Although modern science has paved the way for recovering

from PTSD, a number of sociocultural factors still hinder
most people from seeking help.
Types of PTSD
•Normal Stress Response

•Acute Stress Disorder

•Uncomplicated PTSD

•Complex PTSD

•Comorbid PTSD
 Risk factors

GENDER Age at Trauma

 RACE Less Education

Low Socioeconomic Separated, divorced, or

Status widowed
History of Trauma General childhood
adversity

Personal and family Reported childhood

psychiatric history abuse
Poor social support Initial severity of
reaction to the
traumatic event
Poor social support Initial severity of
reaction to the
traumatic event
ASSESSEMENT
 Patients need to be asked specific questions about their
traumatic experiences to differentiate PTSD from other
psychiatric disorders. These questions should be asked with
sensitivity. Patients are often reluctant to discuss past
traumatic events because of guilt, embarrassment, or
discomfort inherent in revisiting painful memories.

●How do you feel when you recall the event?

●Do you experience dreams or flashbacks about it?
●Do you find yourself avoiding people or activities you
associate with the event?
●Do you find yourself forgetting occurrences from that
period?
●Do you find yourself looking carefully around when you
are in a public place?
Management/treatment
Post-traumatic stress disorder treatment can help you regain
a sense of control over your life. The primary treatment is
psychotherapy, but can also include medication. Combining
these treatments can help improve your symptoms by:

•Teaching you skills to address your symptoms

•Helping you think better about yourself, others and the

world

•Learning ways to cope if any symptoms arise again

•Treating other problems often related to traumatic

experiences, such as depression, anxiety, or misuse of
alcohol or drugs
 Psychotherapy

•Cognitive therapy

•Exposure therapy. 

•Eye movement desensitization and

reprocessing (EMDR)
 Medications

•Antidepressants

•Anti-anxiety medications

•Prazosin
 REACTION

e-PTSD: an overview on how new

technologies can improve prediction and
assessment of Posttraumatic Stress Disorder
(PTSD)