Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?

After an experience of trauma, it is common to experience unwanted memories and disruptions in arousal, but people with PTSD find that these experiences persist. PTSD is experienced by between 3 and 5 people out of every 100 (Kessler et al, 2005) but like many anxiety disorders, it is under-diagnosed and often goes unrecognized (Kasper, 2006). 

The DSM-5 diagnostic criteria for PTSD include:

• Exposure to actual or threatened death, serious injury, or sexual violence.
• Intrusion symptoms associated with the traumatic event in the form of: 
  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
  • Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event.
  • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event were recurring.
  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, or marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event.
• Persistent avoidance of stimuli associated with the traumatic event, 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.
  • Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about (or are closely associated with) the traumatic event.
• Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 
  • The inability to remember an important aspect of the traumatic event.
  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
  • Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others.
  • Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
  • Markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others.
  • Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
• Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 
  • Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
  • Reckless or self-destructive behavior.
  • Hypervigilance.
  • Exaggerated startle response.
  • Problems with concentration.
  • Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

The ICD-11 diagnostic criteria for PTSD include: 

• Exposure to an event or situation of an extremely threatening or horrific nature. Such events include, but are not limited to: 
  • Directly experiencing natural or human-made disasters, combat, serious accidents, torture, sexual violence, terrorism, assault or acute life-threatening illness (e.g., a heart attack).
  • Witnessing the threatened or actual injury or death of others in a sudden, unexpected, or violent manner.
  • Learning about the sudden, unexpected or violent death of a loved one.
• Following the traumatic event or situation, the development of a characteristic syndrome lasting for at least several weeks, consisting of all three core elements:
  • Re-experiencing the traumatic event in the present, in which the event is not just remembered, but is experienced as occurring again in the here and now. This typically occurs in the form of vivid intrusive memories or images; flashbacks, varying from mild (there is a transient sense of the event occurring again in the present) to severe (there is a complete loss of awareness of present surroundings), or repetitive dreams or nightmares that are thematically related to the traumatic event. It is commonly accompanied by strong or overwhelming emotions, such as fear or horror, and strong physical sensations. Re-experiencing in the present can also involve feelings of being overwhelmed or immersed in the same intense emotions that were experienced during the traumatic event, without a prominent cognitive aspect, and may occur in response to reminders of the event. Reflecting on or ruminating about the event and remembering the feelings that one experienced at that time are not sufficient to meet the re-experiencing requirement.
  • Deliberate avoidance of reminders likely to produce re-experiencing of the traumatic event. This may take the form either of active internal avoidance of thoughts and memories related to the event, or external avoidance of people, conversations, activities, or situations reminiscent of the event. In extreme cases the person may change their environment (e.g., move to a different city or change jobs) to avoid reminders.
  • Persistent perceptions of heightened current threat, for example, as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. Hypervigilant persons constantly guard themselves against danger and feel that they or others close to them are under immediate threat, either in specific situations or more generally. They may adopt new behaviors designed to ensure safety (e.g., not sitting with one’s back to the door, repeated checking in vehicles’ rear-view mirrors).
• The disturbance results in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Am I Experiencing Post Traumatic Stress Disorder? is an indicative screening tool, designed to help clients self-assess whether they might meet diagnostic criteria for PTSD, or whether their experiences might warrant further investigation. It is not intended to give a formal diagnosis or provide a measure of severity.

"Some people who report similar experiences to yours have a condition called post traumatic stress disorder. Would you like to try a short quiz that could give us an idea whether this is a problem that troubles you?"

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Kasper, S. (2006). Anxiety disorders: under-diagnosed and insufficiently treated. International Journal of Psychiatry in Clinical Practice, 10(sup1), 3-9.
• Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627. 
• Stansfeld, S., Clark, C., Bebbington, P., King, M., Jenkins, R., & Hinchliffe, S. (2016). Chapter 2: Common mental disorders. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. 
• World Health Organization. (2019). ICD-11: International classification of diseases (11th revision). Retrieved from https://icd.who.int/