![]() ![]() Diminished responsiveness to the external world, referred to as “psychic numbing” or “emotional anesthesia” usually begins soon after the traumatic event. This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who arouse recollections of it (Criterion C2). ![]() Stimuli associated with the trauma are persistently avoided. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event cold, snowy weather or uniformed guards for survivors of death camps in cold climates hot, humid weather for combat veterans of the South Pacific entering any elevator for a woman who was raped in an elevator). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at the moment (Criterion B3). Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed. The traumatic events can be reexperienced in various ways. The likelihood of developing the disorder may increase as the intensity of and physical proximity to the stressor increase. ![]() The disorder may be especially severe or long lasting when the stressor is of human design (e.g. Events experienced by others that are learned about include, but are not limited to violent personal assault, serious accident, or serious injury experienced by a family member or a close friend learning about the sudden unexpected death of a family member or a close friend or learning that one's child has a life-threatening disease. ![]() Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened violence or assault. Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The essential features of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity or witnessing an event that involves death, injury, or a threat to another person or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1).
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