Every successful treatment begins with a correct diagnosis. The VA diagnoses PTSD according to DSM V, the psychiatrist’s diagnostic manual. You have to meet ten criteria to be diagnosed by the VA and included in one of their treatment programs. Private therapists and psychiatrists will often treat clients who do not meet all ten, but most folks I’ve treated met those and more!
First, you must have suffered a Traumatic Event. DSM V 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.
Second, you must have Intrusive Symptoms such as 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.
Third, you must have one symptom of Avoidance defined as:
Persistent, effortful avoidance of distressing trauma-related stimuli after the event, such as:
1) Trauma-related thoughts or feelings.
2) Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
Fourth and Fifth, you must have an increase in Negative Moods and Cognitions (thoughts) after the trauma: You need 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.
Sixth and Seventh, you must have a marked increase in Arousal and Reactivity following the trauma. Two of the following are required:
1) Irritable or aggressive behavior
2) Self-destructive or reckless behavior
3) Hyper vigilance
4) Exaggerated startle response
5) Problems in concentration
6) Sleep disturbance
Eighth: You’ve had this disturbance for at least a month.
Ninth: Your symptoms are severe enough to interfere with daily functioning.
Tenth: Your symptoms are NOT due to another illness, injury, or substance abuse.
Proper diagnosis is important. PTSD is often misdiagnosed as an anxiety disorder, panic disorder, depressive disorder, personality disorder, sleep disorder, or substance abuse disorder. But treatments for those diagnoses will prove inadequate if you actually have PTSD.
So what treatments work? During the next few months, I’ll go over each of the symptom groups in detail including the physiology behind the symptoms. Then I’ll discuss both established and experimental treatment options, other problems associated with PTSD, and some related diagnoses.