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National Collaborating Centre for Mental Health (UK). Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Leicester (UK): Gaskell; 2005. (NICE Clinical Guidelines, No. 26.)

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Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care.

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Appendix 13Diagnostic criteria

Diagnostic criteria for post-traumatic stress disorder in ICD–10 and DSM–IV

ICD–10 diagnostic guidelinesICD–10 research diagnostic criteriaDSM–IV criteria
Stressor criterion
  1. Event or situation of exceptionally threatening or catastrophic nature
  2. Likely to cause pervasive distress in almost anyone
A1 Event or situation of exceptionally threatening or catastrophic nature

2 Likely to cause pervasive distress in almost anyone
A1 The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

2 The person’s response involved intense fear, helplessness, or horror (or disorganized or agitated behaviour in children)
Symptom criterion
Necessary symptom
  1. Repetitive intrusive recollection or re-enactment of the event in memories, daytime imagery, or dreams
Other typical symptoms
2.

Sense of ‘numbness’ and emotional blunting, detachment from others, unresponsiveness to surroundings, anhedonia

3.

Avoidance of activities and situations reminiscent of trauma

Common symptoms
4.

Autonomic hyperarousal with hypervigilance, enhanced startle reaction, insomnia

5.

Anxiety and depression

Rare symptoms
6.

Dramatic acute bursts of fear, panic, or aggression triggered by reminders

Necessary symptoms
B Persistent remembering or ‘reliving’ of the stressor in intrusive ‘flashbacks’, vivid memories, or recurring dreams, and in experiencing distress when exposed to circumstances resembling or associated with the stressor

C Actual or preferred avoidance of circumstances resembling or associated with the stressor which was not present before exposure to the stressor

D1 Inability to recall, either partially or completely, some important aspects or the period of exposure to the stressor
OR
2 Persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor), shown by any two of the following
  1. Difficulty in falling or staying asleep
  2. Irritability or outbursts of anger
  3. Difficulty in concentrating
  4. Hypervigilance
  5. Exaggerated startle response
Necessary symptoms
B The traumatic event is persistently re-experienced in one (or more) of the following ways
  1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions (or repetitive play in which the themes or aspects of the trauma are expressed in children)
  2. Recurrent distressing dreams of the event (or frightening dreams without recognizable content in children)
  3. Acting or feeling as if the traumatic event were recurring (or trauma-specific re-enactment in children)
  4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  5. Physiological reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before trauma), as indicated by three (or more) of the following
  1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
  2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
  3. Inability to recall an important aspect of the trauma
  4. Markedly diminished interest or participation in significant activities
  5. Feeling of detachment or estrangement from others
  6. Restricted range of affect
  7. Sense of foreshortened future
D Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following
  1. Difficulty falling or staying asleep
  2. Irritability or outbursts of anger
  3. Difficulty concentrating
  4. Hypervigilance
  5. Exaggerated startle response
Time frame
Symptoms should usually arise within 6 months of traumatic eventSymptoms should usually arise within 6 months of the traumatic eventSymptoms present for at least 1 month
Disability criterion
NANAThe disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Differential diagnosis
  1. Acute stress reaction (F43.0) (immediate reaction in the first 3 days after event)
  2. Enduring personality change after a catastrophic experience (F62.0) (present for at least 2 years, only after extreme and prolonged stress)
  3. Adjustment disorder (less severe stressor or different symptom pattern)
  4. Other anxiety or depressive disorders (absence of traumatic stressor or symptoms precede stressor)
Same as ICD–10 diagnostic guidelines
  1. Acute stress disorder (duration of up to 4 weeks)
  2. Adjustment disorder (less severe stressor or different symptom pattern)
  3. Mood disorder or other anxiety disorder (symptoms of avoidance, numbing or hyperarousal present before exposure to the stressor)
  4. Other disorders with intrusive thoughts or perceptual disturbances (e.g. obsessive–compulsive disorder, schizophrenia, other psychotic disorders, substance-induced disorders)

Adapted from Ehlers, A. (2000) Post-traumatic stress disorder (Table 1). In New Oxford Textbook of Psychiatry, Vol. 1 (eds M. G. Gelder, J. J. Lopez-Ibor & N. Andreasen), pp. 758–771. Oxford: Oxford University Press. Reproduced by permission of Oxford University Press.

Copyright © 2005, The Royal College of Psychiatrists & The British Psychological Society.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the Royal College of Psychiatrists.

Bookshelf ID: NBK56500

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