KEY FEATURES. Following exposure to a traumatic event, the individual develops a characteristic cluster of symptoms across four categories (intrusion, avoidance, negative changes in thoughts and/or mood, and reactivity). While posttraumatic symptoms often resolve through a natural recovery process, at times that process is interrupted or stalled and PTSD develops. The diagnosis of PTSD is made if the symptoms have been present for more than 1 month after the traumatic event. If the symptoms have lasted for less than 1 month, the diagnosis of Acute Stress Disorder may be made.
REMEMBER: Having PTSD does not make one weak or defective or otherwise at fault. Although the symptoms are frightening and can be severe, this is a highly treatable disorder.
PREVALENCE. The 12-month prevalence in the general population is approximately 3.5%. However, certain individuals are significantly more likely to experience PTSD. These include military personnel, first responders, and survivors of rape. Women are more likely to develop PTSD and experience it for a longer duration. Some of the increased risk appears to be due to a greater likelihood of exposure to interpersonal violence.
DIAGNOSTIC CRITERIA. The diagnostic criteria for this disorder include a combination of (1) exposure to specific types of traumatic events and (2) subsequent symptoms grouped into four categories.
The Traumatic Event
You have been exposed to a traumatic event that was actual or threatened death, sexual violence, or serious injury, in one or more of the following ways:
The Four Categories of Symptoms
The four categories are intrusion, avoidance, negative thoughts and/or mood, and reactivity, beginning after the event occurred. Although there is a total of 20 symptoms across these categories, it is not necessary to have all of them in order to meet the clinical threshold.
Intrusion Symptoms
Avoidance Symptoms
Negative Alterations in Cognition and/or Mood
Alterations in Arousal and Reactivity
Additional Diagnostic Criteria
ASSOCIATED FEATURES. In addition to the diagnostic criteria, an individual with PTSD may also experience auditory pseudo-hallucinations (e.g., hearing your thoughts spoken in one or more different voices), paranoid ideation, or dissociative symptoms, as well as difficulties in regulating emotions or maintaining stable relationships.
DEVELOPMENT & COURSE. Symptoms typically begin within the first 3 months after the traumatic event (although the diagnosis is not made until after the first month). For some, there may be a delay of months, or even years, before the symptoms reach the clinical threshold. It is also possible for some individuals to have a delayed expression of symptoms, in which some of the symptoms appear immediately but there are not enough of them to meet the full diagnostic criteria. Different symptoms may have different duration and intensity. While some individuals reach full recovery within 3 months (about 50% of adults do), others may remain symptomatic for more than a year, for multiple years, or at times even for decades.
KEY FEATURES. Following exposure to a traumatic event, the individual develops a characteristic cluster of symptoms across five categories (intrusion, negative mood, dissociation, avoidance, and reactivity) lasting from 3 days to 1 month (after 1 month, the diagnosis of PTSD may be made).
As you read the diagnostic criteria below, you will see that they very much resemble those for PTSD.
PREVALENCE. The prevalence rates differ based on the nature of the traumatic event and the context in which it is assessed. In cases of motor vehicle accidents, 13%-21% will develop the disorder; 14% in mild traumatic brain injuries; 10% in severe burns; and 6%-12% in cases of industrial accidents. When the event is interpersonal violence, such as assault, rape, or witnessing a mass shooting, the prevalence is 20%-50%. As with PTSD, women are more likely to develop the disorder. Some of the increased risk appears to be due to a greater likelihood of exposure to interpersonal violence (including sexual assault), as well as to possible neurobiological differences in stress response.
DIAGNOSTIC CRITERIA. The diagnostic criteria for this disorder include a combination of (1) exposure to specific types of traumatic events and (2) subsequent symptoms grouped into five categories.
The Traumatic Event
You have been exposed to a traumatic event that was actual or threatened death, sexual violence, or serious injury, in one or more of the following ways:
The Five Categories of Symptoms
You have been experiencing symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and reactivity, beginning or worsening after the event occurred. Although there is a total of 14 symptoms across these categories, it is not necessary to have all of them in order to meet the clinical threshold.
Intrusion Symptoms
Negative Mood
Dissociative Symptoms
Avoidance Symptoms
Reactivity Symptoms
Additional Diagnostic Criteria
ASSOCIATED FEATURES. In addition to the diagnostic criteria, individuals with ASD may experience symptoms that are not required for the diagnosis. For example, they may have extremely negative thoughts about their role in the traumatic event or their response to it (e.g., guilt for not preventing it or for not coping better). In addition, panic attacks are common in the first month after the event. They may be triggered by reminders or occur spontaneously. Individuals may also engage in chaotic or impulsive behavior, such as driving recklessly, making irrational decisions, or gambling. It is also not uncommon to experience “postconcussive symptoms” (regardless of whether there has been an actual mild traumatic brain injury) such as headaches, dizziness, sensitivity to light or sound, irritability, and concentration deficits.
DEVELOPMENT & COURSE. The diagnosis is not made until 3 days after the traumatic event has occurred. If the symptoms persist beyond 1 month, the diagnosis of PTSD may be made. Approximately 50% of individuals who eventually develop PTSD initially meet the criteria for ASD. It is possible for the symptoms to worsen during the first month, whether as a result of ongoing life stressors or additional traumatic events.
RISK FACTORS. Risk factors include prior mental disorder(s), neuroticism (one of the personality traits included in the Five-Factor Model), perception of greater severity of the traumatic event, and an avoidant coping style. A particularly strong risk factor is the tendency to “catastrophize,” which causes the individual to have an exaggerated perception of future harm, guilt, or hopelessness.
There are six distinct adjustment disorders, each with its own diagnostic code.
KEY FEATURES. The presence of emotional and/or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor.
Most people have stress reactions when something negative happens to them. This is not necessarily an adjustment disorder. The diagnosis is only made when the magnitude of the distress exceeds what would normally be expected or when the stressful event causes significant impairment in functioning.
Important: While the symptoms of an adjustment disorder may not appear as severe as those of PTSD and ASD, individuals with adjustment disorders are at an increased risk of suicide attempts and completed suicide.
STRESSORS. There may be just one stressor (e.g., divorce, termination of a romantic relationship, involuntary job termination, change of jobs) or multiple simultaneous stressors (e.g., work difficulties and marital problems). Stressors may be recurrent (e.g., a seasonal business crisis) or continuous (e.g., living in a crime-ridden neighborhood, having a chronic illness with increasing disability). Some stressors are associated with specific phase of life events, such as beginning school, leaving or returning to parental home, getting married, becoming a new parent, or retiring. Lastly, the stressor may be something that affects just one individual, an entire family, or a larger group or community (e.g., as in a natural disaster).
PREVALENCE. Adjustment disorders are common, but their prevalence varies widely. For individuals in outpatient mental health treatment, the prevalence is approximately 5%-20%; for those in a hospital psychiatric consultation setting, it frequently reaches 50%.
DIAGNOSTIC CRITERIA. You may be suffering from an adjustment disorder if you have developed the following symptoms within 3 months after the onset of an identifiable stressor:
DURATION. As indicated above, the symptoms are supposed to start within 3 months of the onset of the stressor and cannot persist for more than 6 months after the termination of the stressor or its consequences. However, it is recognized that there are chronic stressors or those that have enduring consequences. Therefore, the DSM-5 provides two specifiers that address duration: Acute for when the symptoms last 6 months or less, and Persistent (chronic) for when the symptoms last 6 months or longer.
How is an adjustment disorder different from bereavement? You may be diagnosed with an adjustment disorder following the death of a loved one when the intensity or persistence of grief reactions exceeds what normally might be expected. Conversely, bereavement is defined as an expected response to the loss, with symptoms such as intense yearning for the deceased, intense sorrow and emotional pain, preoccupation with thoughts and memories of the deceased, feelings of emptiness and loss, at times thoughts of having failed the deceased (e.g., “I should have visited him more while he was still alive,” “I didn’t tell her enough how much I loved her”), or even thoughts of wanting to “join” the deceased (but not actually following through).
Another point to make is that in the DSM-5, bereavement is not classified as a mental disorder. Instead, it is included in the back of the manual under “Other Conditions” and assigned a “Z” code.
Content based in part on the following two public domain sources: