Which of the 4 categories of PTSD symptoms, listed in Sanderson on page 21, do you feel would be the most difficult for a person to cope with

POST-TRAUMATIC STRESS DISORDER (PTSD)

About one third of survivors of trauma and complex trauma develop symptoms of PTSD and it is more commonly diagnosed in females (Chu, 2011), probably due to females seeking help for their symptoms, while males tend to mask or regulate their symptoms through self-medication and the use of alcohol or drugs. The main criteria for the diagnosis of PTSD are divided into the following four categories: intrusive symptoms, avoidance symptoms, alterations in cognitions and mood and alterations in arousal.

Box 1.1 Symptoms included in Criteria for PTSD (adapted from DSM-V, APA, 2013)

1.Intrusion symptoms – intrusive distressing memories; recurrent distressing dreams; dissociative reactions such as flashbacks through to complete loss of awareness of present surroundings; intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble the traumatic event(s); marked physiological reactions to reminders of the traumatic event(s)

2.Avoidance symptoms – avoidance of distressing memories, thoughts, or feelings associated with the traumatic event(s); avoidance of external reminders (i.e. people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts of, or feelings associated with, the traumatic event(s)

3.Alterations in cognitions and mood – dissociative amnesia for important aspects of the traumatic event(s); persistent and exaggerated negative beliefs or expectations about oneself, others, or the world; distorted blame of self or others about the cause or consequences of the traumatic event(s); persistent negative emotional state (e.g. fear, horror, anger, guilt, or shame); diminished interest in significant activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions (e.g. unable to have loving feelings, psychic numbing)

4.Alterations in arousal and reactivity – irritable or aggressive behaviour; reckless or self-destructive behaviour; hyper-vigilance; exaggerated startle-response; problems with concentration; sleep disturbance

While the current DSM-V (APA, 2013) criteria for PTSD attempt to account for a wide range of trauma reactions they do not offer a comprehensive account for all the symptoms associated with complex trauma. In essence the criteria focus on the primary reactions to trauma such as neurobiological and physiological responses, for example hyper-arousal; intrusive symptoms such as flashbacks; avoidance symptoms; and alterations in cognitions (see Box 1.1). However, the new criteria do not fully account for all the secondary responses that develop in an attempt to cope with the primary traumatic effects such as self-harm, eating disorders, obsessive-compulsive disorders and addictions, which distract from the painful traumatic experiences. The criteria also fail to fully explain changes in personality, profound relationship difficulties or traumatic loneliness.