In my 40 years of practice I saw all types of people, but when they had a grocery list of psychiatric diagnoses, I would always ask them about trauma. PTSD creates so many problems that the actual problem, the trauma, can get lost among the symptoms.
DSM V improved the diagnostic process. It’s still not a perfect system, leaves some survivors out, but if you meet all 8 of the criteria below, you definitely have PTSD.
I. You have to suffer a Traumatic Event.
The DSMV defines this as:
Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one of the following ways:
1) Direct exposure.
2) Witnessing, in person.
3) Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4) Repeated or extreme indirect exposure to aversive details of the events), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.
II. You must experience Intrusive Symptoms
DSM V requires one of the following:
1) Recurrent, involuntary, and intrusive memories.
2) Traumatic nightmares.
3) Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness.
4) Intense or prolonged (emotional) distress after exposure to traumatic reminders.
5) Marked physiologic reactivity (physical distress) after exposure to trauma-related stimuli.
III. You must have Avoidance
DSM V requires one symptom of persistent, effortful avoidance of distressing trauma-related stimuli starting after the trauma, such as:
1) Trauma-related thoughts or feelings.
2) Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
IV. You must have an increase in Negative Moods and Cognitions (thoughts) starting after the trauma:
DSM V requires two of the following:
1) Inability to recall key features of the traumatic event (usually a dissociative amnesia; not due to head injury, alcohol, or drugs).
2) Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous”).
3) Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4) Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
5) Markedly diminished interest in (pre-traumatic) significant activities.
6) Feeling alienated from others (e.g., detachment or estrangement).
7) Constricted affect: persistent inability to experience positive emotions.
V. You must have a marked increase in Arousal and Reactivity starting after the trauma. DSM V requires two of the following:
1) Irritable or aggressive behavior
2) Self-destructive or reckless behavior
4) Exaggerated startle response
5) Problems in concentration
6) Sleep disturbance
VI. Last but not least:
Your symptoms have to be severe enough to interfere with your daily functioning and NOT be due to another illness or injury or substance abuse.
PTSD by itself is called simple PTSD, and PTSD with other mental health issues is called co-morbid PTSD. It’s actually more common to have several diagnoses.
Most common co-morbid diagnoses:
Major Depressive Disorder
Substance Use or Abuse (alcohol, benzodiazepines, opiates, cannabis, and others).
Generalized Anxiety Disorder
Obsessive Compulsive Disorder
Intermittent Explosive Disorder
Personality Disorders (Borderline, Narcissistic, Antisocial, Avoidant, Schizoid)
Brief Psychotic Episode
Dissociative Identity Disorder
When you have other diagnoses along with PTSD, you’ll need treatment for each one. Sometimes treatments overlap. For example, an antidepressant may help both your depression and your PTSD. Some problems may remit with your PTSD treatment, especially anxiety, anger, and sleep disorders. Substance abuse may require separate treatment, but it’s important that ALL your problems get addressed.
You need to share your history of trauma with your doctor and therapist so he/she can understand the source of your symptoms and clarify your diagnosis. You may have more than one problem to face. But If you’re given the wrong diagnosis, you will receive the wrong treatment, and that will significantly slow your recovery time.