About Post Traumatic Stress Injury
Post-Traumatic Stress Disorder (PTSD) is now more commonly known as Post Traumatic Stress Injury which is often a direct result of traumatic scenes and incidents. Unfortunately trauma is the nature of policing and as first responders police are often running towards danger when others are running away. Many years of multiple exposures or a single critical incident can take a toll, not only the brain but in all the body systems resulting in multiple issues which require both somatic and clinical therapy. Trauma literally sits in the body and can go on to cause a range of physical issues such as heart disease, diabetes and inflammatory illnesses.
The PPTSG membership is for those suffering from a range of issues as a result of work related incidents, and who require support in the initial stages but who go on to support others once they have reached a certain stage in their recovery. PPTSG philosophy incorporates a peer to peer support model.
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1. PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.
Note that DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger. The criteria below are specific to adults, adolescents, and children older than six years.
The following outlines the Diagnostic Statistical Manual 5 criteria for PTSD. All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:
Criterion A: stressor (required)
You were exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation. In addition, these events were experienced in one or more of the following ways:
- You experienced the event
- You witnessed the event as it occurred to someone else
- You learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death
- You experienced repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse
Criterion B: intrusion symptoms (one required)
You experience at least one of the following intrusive symptoms associated with the traumatic event:
- Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
- Repeated upsetting dreams where the content of the dreams is related to the traumatic event
- The experience of some type of dissociation (for example, flashbacks) where you feel as though the traumatic event is happening again
- Strong and persistent distress upon exposure to cues that are either inside or outside of your body that are connected to your traumatic event
- Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event
Criterion C: avoidance (one required)
Frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:
- Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
- Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event
Criterion D: negative alterations in cognitions and mood (two required)
At least two of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:
- The inability to remember an important aspect of the traumatic event
- Persistent and elevated negative evaluations about yourself, others, or the world (for example, “I am unlovable,” or “The world is an evil place”)
- Elevated self-blame or blame of others about the cause or consequence of a traumatic event
- A negative emotional state (for example, shame, anger, or fear) that is pervasive
- Loss of interest in activities that you used to enjoy
- Feeling detached from others
- The inability to experience positive emotions (for example, happiness, love, joy)
Criterion E: alterations in arousal and reactivity
At least two of the following changes in arousal that started or worsened following the experience of a traumatic event:
- Irritability or aggressive behavior
- Impulsive or self-destructive behavior
- Feeling constantly “on guard” or like danger is lurking around every corner (or hypervigilance)
- Heightened startle response
- Difficulty concentrating
- Problems sleeping
Criterion F: duration (required)
The above symptoms last for more than one month.
Criterion G: functional significance (required)
The symptoms bring about considerable distress and/or interfere greatly with a number of different areas of your life.
Criterion H: exclusion (required)
The symptoms are not due to a medical condition or some form of substance use.
DSM-5 PTSD Diagnosis
In order to be diagnosed with PTSD according to the DSM-5, you need to meet the following:
- Criterion A
- One symptom (or more) from Criterion B
- One symptom (or more) from Criterion C
- Three symptoms (or more) from Criterion D
- Three symptoms (or more) from Criterion E
- Criteria F through H
How DSM-5 Changed
The biggest change in the DSM-5 is removing PTSD from the category of anxiety disorders and putting it in a classification called “Trauma and Stressor-Related Disorders.”
Other key changes include:
- More clearly defining what kind of events are considered traumatic in Criterion A
- Adding a fourth type of exposure in Criterion A
- Increasing the number of symptom groups from three to four by separating avoidance symptoms into their own group (Criterion C)
- Increasing the number of symptoms from 17 to 20
- Changing the wording of some of the symptoms from DSM-IV
- Adding a new set of criteria for children aged 6 or younger
- Eliminating the “acute” and “chronic” specifiers
- Introducing a new specifier called “dissociative features”
You can review the rationale behind these changes, as well as look at other changes in the DSM-5, at the website for the American Psychiatric Association (APA).
1. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.