| Disorder Class: Anxiety Disorders | Disorder Class: Trauma- and Stressor-Related Disorders |
A. The person has been exposed to a traumatic event in which both of the following were present: The person experienced, 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.
| A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: Directly experiencing the traumatic event(s). Witnessing, in person, the event(s) as it occurred to others. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of family member or friend, the event(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. |
B. The traumatic event is persistently re-experienced in one or more 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 (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Intense psychological distress at exposure to the internal or external cues that symbolize or resemble an aspect of the traumatic event. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
| B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s). Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
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C. Persistent avoidance of stimuli associated with the trauma and the numbing of general responsiveness (not present before trauma), as indicated by three or more of the following: Efforts to avoid thoughts, feelings, or conversations associated with the trauma. Efforts to avoid the activities, places, or people that arouse recollections of the trauma. Inability to recall important aspect of the trauma. Markedly diminished interest or participation in significant activities. Feelings of detachment or estrangement from others. Restricted range of affect (e.g., unable to have loving feelings). Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).
| C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
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| D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: - 1.
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). - 5.
Markedly diminished interest or participation in significant activities. - 6.
Feelings of detachment or estrangement from others. - 7.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). - 4.
Persistent negative emotion state (e.g., fear, horror, anger, guilt, or shame). - 2.
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad;” “No one can be trusted;” “The world is completely dangerous;” “My whole nervous system is permanently ruined”). - 3.
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
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D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper vigilance Exaggerated startle response
| E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following: - 6.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). - 1.
Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. - 5.
Problems with concentration. - 3.
Hyper-vigilance. - 4.
Exaggerated startle response. - 2.
Reckless or self-destructive behavior.
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| E. Duration of the disturbance (symptoms in criteria B, C and D) is more than 1 month. | F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. |
| F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
| H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. |
Specify if: Acute: if duration of symptoms is less than 3 months.
Specify if: Chronic: if duration of symptoms is 3 months or more. | DROPPED |
| Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly). Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). |
| Specify if: With delayed onset: If onset of symptoms is at least 6 months after the stressor. | Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate). |
