OLR Report 2014-R-0123 answers the questions: What is PTSD? What are the symptoms, diagnoses, and treatment for PTSD?
The definition of PTSD has been revised several times over the years. But the Diagnostic Statistical Manual (DSM), which provides standard criteria for the classification and diagnosis of mental disorders by mental health professionals in the United States, classifies it under trauma- and stress-related disorders in its most recent edition, DSM-5, 2013.
PTSD stems from exposure to a traumatic event, such as combat, violent crime, torture, sexual violence, or a natural or man-made disaster, that caused or threatened to cause death or serious injury. It can affect those who (1) personally experience or witness the event; (2) learn that the event happened to a close relative or friend; or (3) experience repeated or extreme exposure to unpleasant or gruesome details of the traumatic event, such as first responders collecting human remains in the aftermath of a disaster (DSM-5, 2013 p. 271).
The typical symptoms associated with PTSD vary, but they include (1) recurring recollections of the traumatic event (“flashbacks”); (2) intense psychological or physiological reaction to cues symbolizing aspects of the event; (3) persistent display of negative emotions (such as fear, anger, guilt, or shame); (4) persistent inability to experience positive emotions (such as happiness, satisfaction, or love); (5) markedly diminished interest in participating in significant activities; (6) angry, reckless, and self-destructive behavior; and (7) avoidance of thoughts or situations reminiscent of the trauma. The symptoms may start soon after the triggering event or may be delayed for months or years after exposure to the event (delayed expression). To be characterized as PTSD, the symptoms must last for more than one month and cause significant impairment in a person’s ability to function. And they cannot be attributable to the physiological effects of a medical condition or substance, such as alcohol. (Separate diagnostic criteria included in DSM for children under age six are not discussed in this report.)
Not everyone who experiences trauma suffers from PTSD. Some research suggests that temperament and genetic makeup have some bearing on the chances of developing PTSD, and it is more likely to affect people with certain predisposing conditions such as depression. But it has also been diagnosed in people with no predisposing conditions. And it can affect people of any age. Research indicates that PTSD rates are higher among veterans and others whose work increases the risk of traumatic exposure (such as police, firefighters, and emergency medical personnel.) Highest rates (ranging from one-third to more than one-half of those exposed) are found among survivors of rape, military combat, and captivity and ethnically or politically motivated internment and genocide. Higher PTSD rates have also been reported among U.S. Latinos, African Americans, and American Indians than Caucasians, and lower rates among Asian Americans, after adjusting for traumatic exposure and demographic variables (DSM-5, p. 276). Events most commonly associated with PTSD in women are rape and sexual violence. In men, the event is combat exposure.
According to the literature, the main types of treatment for PTSD are psychotherapy (counseling), medication, or a combination of both.
The diagnosis of PTSD has its critics. One 2007 study, for example, describes it as a “faddish postulate” that “has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas.” The study authors conclude that “the concept of PTSD has moved the mental health field away from, rather than towards, a better understanding of the natural psychological responses to trauma” (McHugh, P.R. and Treisman G., “PTSD: a problematic diagnostic category,” Journal of Anxiety Disorders 21(2): 211-22). The authors of a 2008 study concluded that the disorder’s “core assumptions and hypothesized mechanisms lack compelling or consistent empirical support” (Rosen G. M. and Lilienfeld S. O., “Posttraumatic stress disorder: An empirical evaluation of core assumptions,” Clinical Psychology Review 28:837-68).
For more information, read the full report.
