Tuesday, August 9, 2016

Trauma, Part One: Definitions and Diagnosis

Any time I write about diagnostic criteria, it is for information purposes only.  I cannot diagnose nor treat anyone over a blog.  If you experience symptoms I discuss on Insight Outside In and are not seeing a mental health professional, I encourage you to access services available to you.  I am happy to answer questions within my scope of knowledge and ability, given the limited nature of this medium.
All right, this one’s a biggie, get comfortable: I am writing about trauma today.
If you personally have an active diagnosis of Post-Traumatic Stress Disorder (PTSD) or have experienced trauma that still causes you distress, you may want to skip this one.  Always do what you can to keep yourself safe.
I’m going to break this up into two entries.  This one will talk about what PTSD is from a diagnostic standpoint, according to the DSM-5.  In my next entry I’ll write more about treatment, coping strategies, and helping a loved one with PTSD.
There are five different criteria for a person to be diagnosed with PTSD.  First, the person has to have had a traumatic experience.  According to American Psychiatric Publishing, the DSM-5 defines a traumatic experience as “exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:
• directly experiences the traumatic event;
• witnesses the traumatic event in person;
• learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
  • experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).”
Next, the person will reexperience the the trauma in one or more ways:
  • Thoughts or perceptions
  • Images
  • Dreams
  • Illusions or hallucinations
  • Flashbacks
  • Distress related to cues that symbolize some aspect of the traumatic event
The third criteria is that the person will avoid stimuli associated with the trauma such as:
  • Avoiding thoughts, feelings, or conversations about the traumatic event
  • Avoiding people, places, things, or situations which remind them of the event.
Fourth, the person will have negative changes in thinking and mood, including two or more of the following:
  • Irritability, angry outbursts
  • Reckless or self-destructive behavior
  • Hypervigilance - the person may be jumpy, or seem more alert to the possibility of threats.  Their senses may seem heightened since their brain is staying in fight-or-flight mode.
  • Being easily startled
  • Trouble concentrating
  • Problems with sleeping
These symptoms must have persisted for at least a month in order for the diagnosis to be PTSD.  They must cause the person distress or interfere with functioning.  Also, the symptoms cannot be better accounted for by a medical condition or substance use.
So, to sum up: 
A person experiences something traumatic.  They start reexperiencing the event by way of things like flashbacks, hallucinations, or nightmares.  They start avoiding things or situations that would remind them of the trauma.  It starts affecting their mood, making them nervous, distracted, irritable.  
These are not things that a person just gets over.  I think that telling someone that they need to “get over it,” or “stop feeling this way” cause more harm, and can exacerbate symptoms.  Tomorrow I’ll write about what can help someone who has experienced trauma, both professionally and personally.

Be well.

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