Post Traumatic Stress Disorder (PTSD) and Prolonged Duress Stress Disorder (PDSD)

What are the symptoms of PTSD?

PTSD, or Post Traumatic Stress Disorder, is a diagnosis given to people who have physical, emotional and mental reactions following a traumatic event. People respond in different ways to extreme trauma. Many people who experience extreme trauma do not develop PTSD. However, for those who do, PTSD symptoms usually appear within several weeks of the trauma, but some people don't experience symptoms until months or even years later.

If you are experiencing PTSD or PDSD (Prolonged Duress Stress Disorder) following some kind of abuse (domestic violence, sexual assault, child abuse) you should know that your reaction is normal!

Symptoms associated with PTSD:

• Re-living the event through recurring nightmares or other intrusive images that occur at any time. People who suffer from PTSD also have extreme emotional or physical reactions such as chills, heart palpitations or panic when faced with reminders of the event.
• Avoiding reminders of the event, including places, people, thoughts or other activities associated with the trauma. PTSD sufferers may feel emotionally detached, withdraw from friends and family, and lose interest in everyday activities.
• Being on guard or being hyper-aroused at all times, including feeling irritability or sudden anger, having difficulty sleeping or concentrating, or being overly alert or easily startled.
• People with PTSD may have low self-esteem or relationship problems or may seem disconnected from their lives.

Other problems that may mask or intensify symptoms include:

• Psychiatric problems such as depression, dissociation (losing conscious awareness of the "here and now") or another anxiety disorder like panic disorder.
• Self-destructive behavior including:
  - Alcohol or drug abuse
  - Suicidal impulses
  - High-risk sexual behaviors that may result in unintended pregnancy or sexually transmitted diseases (STD), including HIV
  - Other high-risk behavior that may be life-endangering, such as fast or reckless driving
  
• Physical complaints, any or all of which may be accompanied by depression, including:
  - Chronic pain with no medical basis (frequently gynecological problems in women)
  - Stress-related conditions such as chronic fatigue syndrome or fibromyalgia
  - Stomach pain or other digestive problems such as irritable bowel syndrome or alternating bouts of diarrhea and constipation
  - Eating disorders
  - Breathing problems or asthma
  - Headaches
  - Muscle cramps or aches such as low back pain
  - Cardiovascular problems
  - Sleep disorders

The diagnostic criteria for PTSD are defined in DSM-IV as follows:

A. The person experiences a traumatic event in which both of the following were present:

• the person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
  
• the person's response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in any of the following ways:

• recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;
  
• recurrent distressing dreams of the event;
  
• acting or feeling as if the traumatic event were recurring (eg reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated);
  
• intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;
  
• physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of:

• efforts to avoid thoughts, feelings or conversations associated with the trauma;
  
• efforts to avoid activities, places or people that arouse recollections of this trauma;
  
• inability to recall an important aspect of the trauma;
  
• markedly diminished interest or participation in significant activities;
  
• feeling of detachment or estrangement from others;
  
• restricted range of affect (eg unable to have loving feelings);
  
• sense of a foreshortened future (eg does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by at least two of the following:

• difficulty falling or staying asleep;
  
• irritability or outbursts of anger;
  
• difficulty concentrating;
  
• hypervigilance;
  
• exaggerated startle response.

E. The symptoms on Criteria B, C and D last for more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Prolonged Duress Stress Disorder (PDSD)

The focus of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include:

• repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (eg bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in aeroplane disasters, etc)
  
• repeated involvement in dealing with serious crime, eg where violence has been used and especially where children are hurt
  
• breaking news of bereavement caused by accident or violence, especially if children are involved
  
• repeated violations such as in verbal abuse, physical abuse and sexual abuse
  
• regular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc

Where the symptoms are the result of a series of events, the term Prolonged Duress Stress Disorder (PDSD) may be more appropriate. Whilst PDSD is not yet an official diagnosis in DSM-IV or ICD-10, it is often used in preference to other terms such as "rolling PTSD" and "cumulative stress".

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