Mar 20, 2011

How to Diagnose Post-traumatic Stress Disorder

Diagnostic criteria for PTSD based on Diagnostic and Statistical Manual of Mental Disorders IV, Text Revision

To make the formal diagnosis of PTSD the following diagnostic criteria must be met:

1. Exposure to traumatic event
  • Experiencing, witnessing or being confronted with an event involving serious injury, death or a threat to person’s physical integrity
  • Response, involving helplessness, intense fear or horror
  • Agitation or disorganized behavior for children

2. Persistent re-experiencing
  • Thoughts or perception, images, dreams, illusions, hallucinations, dissociative flashback episodes, intense psychological distress or reactivity to situations that remind of the event
  • Children re-experience the event through repetitive play.

3. Avoidance and emotional  numbing - 3 or more of the following must be present:
  • Avoidance of thoughts, feelings or conversations that are associated with the event
  • Avoidance of places, people, or activities that may trigger recollection of the event
  •  Inability to recall important aspects of the event
  •  Significantly diminished interest or participation in important activities
  • Feeling of detachment from others
  • Narrowed range of effect
  • Sense of having a foreshortened future

4. Hyperarousal – 2 or more of the following symptoms must be present
  • Difficulty sleeping or falling asleep
  • Decreased concentration
  •  Hypervigilance
  • Outbursts or anger or irritable mood
  • Exaggerated and started response

5. Duration of symptoms for more than 1 month
If the above-mentioned symptoms are present, but 30 days have not elapsed, the individual is diagnosed with Acute Stress Disorder.

6. Significant impairment in functioning

Children may react differently to trauma than adults.

For children 5 years or younger:
  • Typical reactions can include fear of being separated from parent, crying, whimpering, screaming, immobility, aimless motion, trembling, frightened expressions, excessive cling.
  • Regressive behavior may also be observed.

Children aged 6-11 years may show:
  • Extreme withdrawal, disruptive behavior, inability to pay attention, regressive behavior, nightmares, sleep problem, irrational fears, irritability, refusal to attend school, outbursts of anger, fighting
  • Somatic complaints without medical basis
  • Depression, anxiety, feeling of guilt, emotional numbing


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Mar 9, 2011

Pathophysiology of Post-traumatic Stress Disorder

Biochemical changes in the brain and body have been observed in majority of people diagnosed with Post-traumatic Stress Disorder.  In laboratory studies it was seen that cortisol secretion in the urine is decreased, while catecholamine (norepineprine and epinephrine) is elevated in PTSD cases. Consequently, norepinephrine/cortisol level is higher than in normal individuals.  On the other hand, catecholamine level in the brain is low, whereas corticotrophin-releasing factor (CRF) concentration is high. These findings suggest abnormality in the hypothalamic-pituitary-adrenal axis.

The key areas of the brain that are implicated in the development of PTSD are amygdala, prefrontal cortex and hippocampus.

  • Amygdala is associated with the formation of emotional memories, especially fear-related.  Research has shown that traumatic stimuli lead to fear conditioning which results to activation of amygdala, hypothalamus, locus cereleus, periaqueductal gray and parabrachial nucleus and its accompanying neurotransmitters. Thus, the symptoms of PTSD are produced.
  • The Vietnam Head Injury Study showed that damage to the prefrontal cortex may actually be protective against later development of PTSD.
  • Gurvits et al found out that combat veterans who suffered from PTSD had 20% reduction in the volume of their hippocampus compared to veterans who were not afflicted with it.

  1. Post-traumatic Stress Disorder. Wikipedia
  2. Post-traumatic Stress Disorder Overview. Medscape
  3. Post-traumatic Stress Disorder Diagnosis. Medscape
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Post-traumatic Stress Disorder Overview
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Mar 7, 2011

Post-traumatic Stress Disorder

Pfc. John Dwyer,  a medic during the Iraq war, who died
after suffering from PTSD 

Imagine yourself in the midst of the strong earthquake that had just hit the town of Christchurch in New Zealand, seeing buildings crumbling in a blink of an eye. Or how about witnessing how the chaos in Libya unfolds and being in the hordes of people, joining the exodus. How do you think you would react?  Can you easily erase that harrowing ordeal from your memory? Probably not. Children who came home to the Philippines after, escaping the war-torn Libya were reported to have been showing some inadequate behaviors like, crying without apparent reason, trembling and trouble sleeping. These children might develop Post-Traumatic Stress Disorder without proper intervention.

Post-traumatic stress (PTSD) disorder belongs to a group of anxiety disorder. It can develop after exposure to traumatic events, such as war, natural disaster, violent assault, sexual assault, kidnapping, accidents, terrorist attacks and other life-threatening conditions. Children may even develop PTSD symptoms after having been bullied.

Patients with PTSD may complain of flashbacks, difficulty sleeping or nightmares, feeling alone, angry outbursts and feeling worried, guilty or sad.  These signs may start soon after the frightening event or even years later. To be considered a PTSD the symptoms should be present for 1 month or more. It should be persistent enough to cause disruption of daily activities or functional impairment.

PTSD can happen on anyone at any age, including children.

PTSD can be acute (symptoms lasting less than 3 mos.), chronic (symptoms lasting 3 mos. Or more), or delayed onset (6 mos. elapses from the event to symptom onset).

The earliest description of PTSD was made by the Greek historian Herodotus in 490 BC. An Athenian soldier became permanently blind after witnessing the death of a fellow soldier in the Battle of Marathon.

The United States Department of Veterans Affairs estimates that 830,000 Vietnam War veterans suffered symptoms of PTSD.

Surveys of about 3,700 people who survived the World Trade Center attack found that about 96% still had at least one symptom of PTSD two to three years later.

In recent history, 2004 Indian Ocean tsunami and the Haiti earthquake may have caused PTSD in many survivors and rescue workers.

PTSD has a lifetime prevalence of 8-10%. Females are at higher risk than males. Sexual assault has the most impact on women, whereas for men it is combat trauma.

Risk Factor for PTSD

Researchers identified the following as the predisposing factors for the development of PTSD:

  •     Characteristics of the trauma exposure itself (proximity , severity and duration of exposure)
  •     Characteristics of the individual prior to trauma exposure (family history of prior psychiatric illness,  gender)
  •      Post-trauma factors (availability of social support, emergence of avoidance, numbing, hyperarousal and re-expereincing symptoms)

  1. Post-traumatic stress disorder. Wikipedia
  2. Post-traumatic stress Disorder. Emedicine
  3. Post-traumatic Stress Disorde. National Institute of Mental Health
Related Articles:
Pathophysiology of Post-traumatic Stress Disorder
How to diagnose Post-traumatic Stress Disorder