Post-traumatic stress disorder

What it is

Post-traumatic stress disorder is set apart by the nature of its stressor. In PTSD the stressor is usually exposure to actual death or the threat of it, to serious injury, or to sexual violence. In short, the stressor in PTSD is catastrophic.

Exposure is given four ways: direct, witnessed, learned of a close one, or repeated exposure, as in EMS work. The duration is more than 1 month, and the onset is any time after the trauma, often within 3 months.

Causes and risk

The stressor is the catastrophic kind just named. PTSD also sits with other diagnoses: 25% of patients with BPD suffer from posttraumatic stress disorder as well, and most researchers believe there is a close association between childhood physical and sexual abuse and BPD, with forty to seventy-one percent of those patients reporting a history of sexual abuse.

The four symptom clusters

The DSM-5 criteria are given as four, all of them required:

1. Intrusion: nightmares, flashbacks, intrusive thoughts
2. Avoidance of reminders
3. Negative mood or cognition: guilt, detachment, amnesia
4. Hyperarousal: insomnia, startle, irritability, hypervigilance

Seen in the clinic the same four come out as a longer list: insomnia, flashbacks, hyperarousal and hypervigilance, unresponsiveness to surroundings, startle, blunting of emotions, avoidance, anhedonia, alcohol and aggression, numbness, detachment, depression and delayed response.

In children PTSD shows as regression and as nightmares without recognition of the trauma.