Boundary with normality
A history of exposure to an event or situation of an extremely threatening or horrific nature
does not in itself indicate the presence of PTSD. Many people experience such stressors without
developing a disorder. Rather, the presentation must meet the above diagnostic requirements of the
disorder. Normal acute reactions to traumatic events can show all the symptoms of PTSD including
re-experiencing, but these begin to subside fairly quickly (e.g., within one week) after the event
terminates or removal from the threatening situation. If clinical intervention is warranted in these
situations, assignment of the category Acute Stress Reaction from the chapter on Factors Influencing
Health Status and Encounters with Health Services (i.e., a non-disorder category) is generally most
appropriate. PTSD symptoms may also be observed in situations where the stress is continuing and removal is
not possible (e.g., war). Under these conditions, PTSD can be differentiated from normal chronic
stress reactions by slow, limited, or lack of adaptation to the stressful situation and the presence
of a substantially greater degree of continuing distress and interference with functioning.
|
Boundary with other conditions
In Complex PTSD, people have symptoms that meet the definitional requirements of
PTSD plus the added elements of sustained and pervasive difficulties in emotion regulation, negative
beliefs about self, and interpersonal functioning. Unlike Adjustment Disorder, which can persist for up to six months after stressors
of any severity, PTSD can only be diagnosed if the individual has been exposed to a severe, usually
life-threatening, stressor and presents with the three core PTSD symptoms. In some cases, situational or conditioned specific phobias can arise after being
exposed to a traumatic event but PTSD and phobias can be differentiated particularly by the absence
of re-experiencing. Although in phobic responses there may be powerful memories of the event in
response to which the individual experiences anxiety, the memories are experienced as belonging to
the past. In PTSD, panic attacks can be triggered by reminders of the traumatic event(s) or in
the context of re-experiencing. The presence of panic attacks that occur entirely in the context of
event reminders or re-experiencing does not warrant an additional, separate diagnosis. In a Depressive Episode, intrusive memories are not experienced as occurring again
in the present, but as belonging to the past, and they are often accompanied by rumination. However,
Depressive Episodes commonly co-occur with PTSD; if the definitional requirements are met for both,
both conditions should be diagnosed. In PTSD, as opposed to Schizophrenia Spectrum and Other Primary Psychotic Disorders,
the hallucinatory experiences and delusional beliefs are limited to flashbacks or episodes of
re-experiencing related to an identifiable traumatic event.
|
