Clinical descriptions and DSM criteria

1. Karen Kneisley
Child & Adolescent Psychopathology
Argosy University

2. PTSD is an abnormal reaction to
an abnormal event involving a
complex interaction of
biological, psychological, and
social causes. (Yehuda &
McFarlane, 1995)

3. o Majority of individuals exposed to trauma do
not develop the disorder
o Not rare relative to other disorders
o DSM-IV cites prevalence rates ranging from 3%
to 8%
o Of 5,687 young Americans reactions to
Hurricane Hugo, 5.4% met Criteria A-D for
PTSD
o 3.5% of youths seeking alcohol or drug care
were diagnosed with PTSD

4. o 3% of those using mental health
services
o 2.8% of those identified with serious
mental health problems at school
o 1.7% of those in the child welfare
system
o 3.1% of those in the juvenile justice
system

5. A. The person has been exposed to a traumatic event in which both of the
following were present :
(1) the person experienced, witnesses, 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
(2) the person’s response involved intense fear, helplessness, or horror. Note :
In children, this may be expressed instead by disorganized or agitated
behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the
following ways:
(1) recurrent and intrusive distressing recollections of the event, including
images, thoughts, or perceptions. Note: In young children, repetitive play
may occur in which themes or aspects of the trauma are expressed.

6. (2) recurrent distressing dreams of the event. Note: In children, there
may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring
( includes a sense of reliving the experience, illusions,
hallucinations, and dissociative flashback episodes, including those
that occur on awakening or when intoxicated). Note: In young
children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event
(5) Physiological reactivity on exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event.

7. C. Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness ( not present before the trauma),
is indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with
the trauma
(2) efforts to avoid activities, places, or people that arouse recollections
of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant
activities
(5) feelings of detachment or estrangement from others
(6) restricted range of affect ( e.g., unable to have loving feelings)
(7) sense of foreshortened future (e.g., does not expect to have a career,
marriage, children, or a normal life span)

8. D. Persistent symptoms of increased arousal ( not present before the
trauma), as indicated by two (or more) of the following:
(1) difficultly falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D ) is
more than 1 month.
F. The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.

9. o Combat
o Violent crime
o Childhood physical or sexual abuse
o Accidents
o Natural disasters

10. Re-experiencing
o Repetitive and intrusive thoughts
o Vivid re-enactment of the trauma
o Sleep cycle disturbances
o Changes in mood and behavior

11. Avoidance
o Avoid thoughts and feelings or situations
or activities
o Suppression of negative affect
o Emotional constriction
o Foreshortened view of the future

12. Hyper-Arousal
o Exaggerated startle response
o Poor concentration
o Hypervigilance
o Irritability

13. Biological vulnerability
o Genetic vulnerabilities
o Associations between PTSD and
family histories
o Genetic component

14. Psychological strengths and
vulnerabilities
o Personal control
o External locus of control
o Internal locus of control

15. History of Psychiatric Problems
o Prior developmental & psychiatric
problems
o Positive associations with psychiatric
histories

16. Experiential Vulnerabilities
o Gender differences
o Internalizing & externalizing
behaviors

17. Ethnic and Cultural Variations
o Reactions to acute, nonabusive
stressors
o Reactions to chronic or abusive
stressors

18. Developmental Differences
o Reactions to overwhelming
stimuli
o Cognitive development

19. o Social support
o Parenting style
o Family discord vs. cohesion

20. o Focus on the self, environment or other
o Serve to solve problems or manage emotions
o Coping styles can include-
 Information seeking
 Support seeking
 Direct action
 Inhibition of action
 Intrapsychic coping

21. o Trauma Symptom Checklist for Children
o Child’s Reaction to Traumatic Events
o Child PTSD Reaction Index
o Childhood PTSD Interview
o Children’s PTSD Inventory
o Child Behavior Checklist

22. o Psycho-education
o Symptom-monitoring
o Re-establishing routines
o Coping skills training
o Graded exposure
o Safety skills & self-regulation
o Parent training