**B: Persistent re-experiencing**

One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).

#### **C: Persistent avoidance and emotional numbing**

This involves a sufficient level of:


#### **D: Persistent symptoms of increased arousal not present before**

These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hypervigilance.

### **E: Duration of symptoms for more than 1 month**

If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with 'acute stress disorder'.

#### **F: Significant impairment**

The symptoms reported must lead to "clinically significant distress or impairment" of major domains of life activity, such as social relations, occupational activities, or other "important areas of functioning".

In preparation for the May 2013 release of the DSM-5, the fifth version of the American Psychiatric Association's diagnostic manual, draft diagnostic criteria was released for public comment, followed by a two-year period of field testing. Proposed changes in DSM-5, to the criteria include:


Post Traumatic Stress Disorder – An Overview 13

sessions that may occur twice a week. High-risk concerns such as psychosis, homicidal or

Cognitive Processing Therapy is an approach that focuses primarily on trauma-related attributions and cognition that are maladaptive. There is exposure to the trauma, but it occurs in a modulated fashion and is accomplished through having victims write descriptions of the trauma that are repeatedly reviewed and read. The description is analyzed to identify blocks and dysfunctional cognitions and cognitive therapy techniques are used to challenge and replace these distortions with more appropriate, accurate and adaptive views. Themes of safety, trust, power, esteem and intimacy are specifically addressed. Coping skills are taught to assist victims in predicting and managing stress responses. CPT has been proven effective with female rape victims. Resick and Schnicke (1995) provide the theory underlying the approach and a detailed description of the various

SIT is a CBT approach that has a primary focus on teaching the identification and management of anxiety reactions to stressful situations. Michenbaum (1985) first developed this intervention for use with a wide variety of populations suffering from anxious response including trauma. SIT involved explaining the physical, cognitive and behavioral components of fear and anxiety reactions. Then victims are taught various coping strategies to address dysfunctional thoughts and unpleasant feelings that come up with exposure to certain trauma reminders. These include relaxation, shifting attention and self-coaching dialogues. The goal is that victims learn to manage trauma related anxiety with confidence and efficacy. SIT has been found effective with various stress-related conditions and for

Shapiro (1995) developed the Eye Movement Desensitization and Reprocessing (EMDR) approach. Like SIT, this approach has been advocated as a treatment for a variety of psychological problems involving intense emotions and intrusive thoughts. It is generally considered a form of imaginal exposure accompanied by cognitive re-framing, which are standard elements of CBT. Victims are encouraged to imagine a stressful scene and replace dysfunctional cognitions with more adaptive ones while engaging in lateral eye movements. Therapists move fingers back and forth to facilitate this process. The unique aspect of the treatment is the eye movement component. The currently available research has established EMDR is as effective as CBT treatments [42]. However, the eye movements have not been found to be necessary and they do not explain symptom reduction. Initially, it was claimed that EMDR could cure PTSD in one or two sessions. The developer of the method now takes the position that up to 12 sessions may be necessary in some cases to achieve full effects.

Though seldom the sole, or even primary treatment for PTSD, pharmacotherapy can alleviate suffering, help restore immediate functioning, and be a supportive adjunct to psychotherapy [43,44]. The scientific literature on PTSD pharmacology is relatively sparse. Most studies have been trials of different medications, only a few randomized trials have been conducted and they have had equivocal results. Treatment guidelines are largely developed on the basis of clinical experience and expert opinion. Antidepressants are the

suicidal tendencies should be addressed. **2. Cognitive Processing Therapy (CPT)** 

techniques. The treatment occurs over 12 sessions.

female rape victims. Typically this approach consists of 8-14 sessions. **4. Eye Movement Desensitization and Reprocessing (EMDR)** 

**3. Stress Inoculation Training (SIT)** 

**8.2 Pharmacotherapy of adult PTSD** 


PTSD is a clinical diagnosis; there are no laboratory tests or brain-imaging studies currently used in clinical practice to diagnose PTSD. Brain imaging studies are under way to learn more about the brain in the PTSD condition, but these are not used in everyday medical practice. A physical exam and some blood tests may be necessary to rule out medical conditions that may mimic PTSD, such as hyperthyroidism which can create an anxiety state.
