According to the DSM-5, “The essential feature of PTSD is the development of characteristic symptoms following exposure to one or more traumatic events” (1).
- symptoms usually appear shortly after trauma but a smaller proportion of patients is said to have a delayed presentation where they start at least six months later (less than 15%) (2,3)
- most symptoms will resolve spontaneously within the first month or so while some may persist and become clinical symptoms that meet criteria for one or more posttraumatic diagnoses, per the DSM-5
- if symptoms last for more than a month, they may then meet criteria for PTSD (1).
Symptoms of PTSD have been described in the DSM-5 which mainly include
- recurrent, involuntary, and intrusive recollections of the event
- avoidance of stimuli associated with the trauma
- negative alterations in cognitions or moods associated with the event, or numbing (or both)
- alterations in arousal and reactivity, including a heightened sensitivity to potential threat
The symptoms of PTSD and the relative predominance of different symptoms may vary over time. Symptom recurrence and intensification may occur in response to reminders of the original trauma, ongoing life stressors, or newly experienced traumatic events (1).
In addition, patients with PTSD may show features of secondary (mal) adaptations to the traumatisation as a means of coping with and blunting physical and emotional/existential pain. These may include:
- increased risks to safety and well-being of self and others e.g. - suicidal risk and self-injury, exposure to physical danger, violence and abuse to and from others, and sexual risk-taking)
- substance and behavioural addictions
- physical injury
- medical conditions and illnesses (and their associated treatment burdens and medical costs
- relational distress and discord e.g. - difficulty developing and maintaining intimate and trusting relationships and problems with parenting
- social disruption
Furthermore, many patients with PTSD will have:
- decreased ability to function at work or school resulting in underemployment, job loss, anger, difficulty with authority figures and criminal justice involvement
- however in some it may be the opposite with work serving as a means of keeping the trauma at bay or coping with their ongoing or intermittent trauma symptoms
- co-occuring mental disorders
- major depressive disorder
- generalized anxiety
- substance abuse
- a heightened risk for a variety of other mental health and health/medical problems
- social problems (1).
- non specific symptoms like palpitations, shortness of breath, tremor, nausea, insomnia, unexplained pain and mood swings resulting in repeated attendance to a GP (3).
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