I was recently approached by a California-based psychiatric treatment practice to feature writings by their experts on my blog. I agreed to give it a try. The following may shed some light on the new criteria for being diagnosed with PTSD and provide insight into how children can also be affected by abuse and trauma. We need to take the necessary steps to protect ourselves and our children. Never be ashamed to ask for help.
New Diagnostic Criteria for Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a severe psychological condition in which exposure to a traumatic event causes clinically significant symptoms that cause substantial distress or interferes with social, occupational, or developmental functioning. The criteria that mental health professionals use to diagnose PTSD were recently updated with the release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May of 2013.
In this article I will briefly review what changes were made and how to understand them. If you or a loved one has been exposed to a traumatic event, you may recognize some or many of the symptoms below. Please remember that only a trained mental health professional is qualified to make a diagnosis of PTSD. If you suspect that you or a loved one has PTSD, please have an evaluation by a psychologist or another mental health professional at your earliest opportunity.
Post-Traumatic Stress Disorder Grouped Within A New Class of Mental Disorders
The DSM-5 has created a new class of mental disorders called “Trauma and stressor related disorders.” PTSD is now included within this class rather than seen as an Anxiety Disorder as in previous versions. The diagnostic criteria for PTSD itself have also been revised, as described below.
To diagnose PTSD, an individual must be exposed to the threat or experience of: sexual violence, serious injury, or death. This exposure can take the form of either direct exposure, direct witnessing, indirect witnessing through hearing of a close friend or relative’s exposure to trauma, or repeated or extreme indirect exposure to details of trauma in the line of professional duty such as members of the armed forces, policemen, and firefighters. Exposure to trauma via electronic or social media does not alone constitute a basis to develop PTSD.
In addition to having been exposed to a traumatic event, the individual must display symptoms of impairment in four other areas of functioning for a month or longer. Intrusive Symptoms include recurrent involuntary memories of the trauma, traumatic nightmares, flashbacks, or intense distress when exposed to a reminder of the trauma. Avoidance includes efforts to avoid trauma-related thoughts and feelings as well as things or situations that may remind the person of the trauma such as objects, locations, situations, people, and places. Negative changes in thoughts and feelings include difficulties remembering important aspects of the trauma, pervasive negative feelings about oneself related to the trauma, loss of interest in daily activities, ongoing feelings of shame, horror, guilt, or anger, feeling alienated from others, and/or an inability to feel emotions. Changes in emotional reactivity include increased irritability or aggression, self-destructiveness, startling easily, problems with concentration, sleep disturbance, or being overly fearful.
PTSD in Adolescents
PTSD in children and adolescents is common. According to the United States Department of Veterans Affairs, the most common form of child abuse in the United States is neglect, followed by physical abuse, sexual abuse, and mental abuse. Boys and girls are equally likely to be exposed to trauma over the course of their childhoods. Studies show that between 3-15% of girls and 1-6% of boys develop PTSD at some point in their childhood.
Teenagers with PTSD may show many signs and symptoms that are similar to adults with PTSD. However, teens with PTSD are more likely to exhibit the following symptoms:
- Sexually inappropriate behavior, sexual promiscuity
- Self-harming behavior such as cutting or burning themselves
- Suicidal thoughts or actions
- Aggressive behaviors toward others
- Drug and alcohol abuse
- Social isolation and withdrawal, few if any friends, poor choice of friends
- Acting out behavior such as defying authority, petty theft, breaking rules
- Lack of trust in adults, sexually inappropriate behavior toward adults
- Excessive fear, anxiety, worry, sadness, low self-worth, exaggerated startle response
- Excessive shame, avoidance of eye contact, withdrawn body language
It is important to consider these indicators in boys as well as girls, as boys may express their trauma symptoms in a more aggressive fashion and thus may be seen as evidence of delinquency or “bad character” rather than as signs and symptoms of PTSD.
If you suspect that you or your loved one has PTSD, make an appointment to be evaluated at your earliest opportunity with a qualified mental health professional. There are other psychological conditions that may appear to be similar to PTSD, so getting an accurate diagnosis is essential. PTSD can also occur along with other conditions such as drug and alcohol abuse, major depression, and bipolar disorder. Getting an accurate and comprehensive diagnosis through a psychiatric treatment center or a dual diagnosis treatment center is essential.
There are many highly effective treatments for PTSD. PTSD is primarily treated with psychotherapy. Medications are not the primary treatment of choice for PTST but they may help with complications of PTSD such as anxiety, nightmares, and depression.
About the Author: Keith Valone, Ph.D., Psy.D., M.S.C.P. is clinical psychologist, certified psychoanalyst, and clinical psychopharmacologist. He is the founder and CEO of The Arroyos® Treatment Centers and The Arroyos® Psychological Associates in Pasadena, California.