Demystifying the DSM-V: PTSD

scriptshrink:

Alright.  Time for a heavy topic.

First off, for these disorders, your character needs to have gone through a traumatic event (or multiple ones).

Note – there are two different sets of criteria for PTSD.  One is for adults and children older than six; the other is for children 6 years and under.

These are the adult criteria:

A trauma is defined as being exposed to actual or threatened death, serious injury, or sexual violence, in one or more of the following ways:

1. Directly experiencing it
2. Witnessing in person the trauma as it happened to someone else
3. Learning that the trauma happened to a close family member or friend. If the person dying or nearly dying is the traumatic event, it has to have been violent or accidental
4. The character has been repeatedly and excessively exposed to awful details of traumatic events.  This is typically seen in first responders, police officers investigating child abuse, etc.

So your character has, in some way, been through something pretty hellish. What comes next? As I discussed in one of my earliest posts, not everyone going through a traumatic event gets PTSD.  There are a lot of factors involved.

But your character is one of the unlucky ones.

There are few clusters of symptoms the character needs to have experienced some of to get a diagnosis of PTSD.

Intrusion (1 or more of the following):

• Repeated, unwanted, inescapable and extremely stressful memories of the trauma
• Frequent nightmares about or similar to the trauma
• In children above 6, the nightmares may not seem related
• Dissociative reactions / Flashbacks – the character feels or acts as if the trauma is happening again.  Flashbacks range from relatively mild to severe (to the point where the character loses all awareness of their present surroundings)
• Children above 6 might reenact the trauma in play
• Severe stress when the character is exposed to internal or external cues that are similar to the trauma
• An example would be someone who nearly died in a car crash freaking out when riding in a car and someone slammed on the brakes.
• Bodily reactions to internal or external cues that are similar to the trauma
• Such as someone’s heart pounding and feeling like they’re going to pass out when they’re being followed

Avoidance (1 or both of the following):

• The character avoids (or tries to avoid) memories, thoughts, or feelings related to the trauma.
• The character avoids (or tries to avoid) external reminders (such as people, places, objects, situations) of the trauma.

Negative Cognition / Mood (2 or more of the following):

• The character can’t remember an important part of the trauma 
• The character has enduring, strong negative beliefs / expectations about people, the world, or themselves
• Ex – “No one can be trusted,” “I’m tainted goods,” “I am a bad person”
• The character’s thoughts about what caused or resulted from the trauma are distorted, leading the character to blame themselves or others
• “It’s all my fault – I brought this on myself”, “This would never have happened to me if you hadn’t…”
• Persistent negative emotional state (fear, horror, anger, guilt, shame)
• The character can’t experience positive emotions, such as happiness, or love
• The character isn’t as interested in activities they used to like
• The character feels distant or estranged from others

Arousal and Reactivity (Not that kind of arousal. Seen through 2 or more):

• The character is irritable and angry
• This can be seen through verbal or physical aggression towards people or objects
• The character is reckless and self-destructive
• Hypervigilance – see my post here!
• Exaggerated startle response – when the character is surprised, they flip out
• Problems concentrating
• Trouble sleeping / insomnia

All of these symptoms have to have been experienced by the character for more than 1 month.

These symptoms cause the character stress and seriously makes their life more difficult.

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PTSD for children under 6

Alright, now PTSD for children 6 or younger is slightly different.

A trauma in this case is defined as being exposed to actual or threatened death, serious injury, or sexual violence, in one or more of the following ways:

1. Directly experiencing it
2. Witnessing in person the trauma as it happened to someone else, especially caregivers
3. Learning that the trauma happened to a parent or caregiving figure.

Again, there are clusters of symptoms required.

Intrusion (1 or more of the following):

• Repeated, unwanted, inescapable memories of the trauma
• These memories may not always appear distressing, and may be shown through play reenactment of the trauma.
• Frequent nightmares that may or may not be related to the trauma
• Dissociative reactions / Flashbacks – the character feels or acts as if the trauma is happening again.  Flashbacks range from relatively mild to severe (to the point where the character loses all awareness of their present surroundings)
• Children above 6 might reenact the trauma in play
• Severe stress when the character is exposed to internal or external cues that are similar to the trauma
• Bodily reactions to internal or external cues that are similar to the trauma

One or more of Avoidance OR Negative Cognition / Mood 

• The character avoids (or tries to avoid) activities, places, or physical reminders of the trauma.
• The character avoids (or tries to avoid) people, conversations, or social interactions that remind them of the trauma

• The character is much more frequently in a bad or sad mood
• The character isn’t interested in activities they previously liked, or don’t play very much
• They’re withdrawn socially
• They don’t seem to experience positive emotions frequently

Arousal and Reactivity (Not that kind of arousal. Seen through 2 or more):

• The character is irritable and angry, resulting in extreme temper tantrums
• Hypervigilance – see my post here!
• Exaggerated startle response – when the character is surprised, they flip out
• Problems concentrating
• Trouble sleeping / insomnia

All of these symptoms have to have been experienced by the character for more than 1 month.

These symptoms cause the character stress and seriously makes their relationships with others strained.

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There are a couple specifiers for both types.  First, the character may have dissociative symptoms – specifically depersonalization and/or derealization (see my post here!)

You also need to specify if the PTSD had a delayed expression – meaning that all the criteria were not met until at least 6 months after the trauma.