Mental health is an important dimension of an individual's overall health, World Health Organizations (WHO) definition of health clearly stresses on the importance of positive mental health by defining health as, ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Among these three dimensions, mental health is the most underestimated and frequently goes overlooked as often physical and social factors, such as immunization coverage or poverty reduction, receive more attention at the policy making level.
Post-traumatic stress disorder PTSD is a psychiatric condition, a type of anxiety disorder, which develops in people affected from instances of extreme stress. It is more likely to develop in individuals exposed to massive death and destruction, such as people who have witnessed or survived terrorist bombing. A number of symptoms that co-exist with one another characterize PTSD, which includes reliving experiences or flashbacks, avoidance of stimuli associated with the trauma and hyper-vigilance.
Posttraumatic stress disorder is distinctive from other psychiatric disorders, such that it necessitates the involvement of an explicit type of trauma to transpire after which the affected exhibits trauma-related distress. In that sense, physicians and psychiatrists make the diagnosis of PTSD based on a conceptual framework that distinguishes traumatic events form the usual stressful experiences.
There are two competing systems, the ICD-10 and the DSM-IV, both have similar characterization of PTSD and trauma but minor differences in terms of their diagnostic criteria. For example instead of a criterion based diagnosis, like the DSM-IV the ICD-10 describes the condition relying upon its general signs and symptoms.
It is crucial to assess the symptoms at regular interval along the period of the trauma in order to comprehend the relationship between the stress reactions and a specific traumatic experience. Several researches demonstrate that PTSD symptoms are exceedingly common in the instantaneous aftermath of traumatic experiences. Researchers assessed rape victims and found that 94% of the victims exhibited sever PTSD symptoms. They reassessed the victims after a period of 6 months and discovered that only 39% of the victims reported having symptoms of PTSD.
Similarly, the studies done after 9/11 attacks, reported high levels of PTSD symptoms in the residents of New York City, which demonstrated a steady decline after a period of six months as well. Many studies also demonstrated that some cases of PTSD achieved spontaneous recovery within the first year of trauma exposure. Whereas those cases who did not recover within the first year were at high risk of developing other psychological illnesses alongside PTSD. Therefore, it is necessary to identify individuals at risk of developing chronic PTSD amidst the ones presenting early PTSD symptoms.
Reproducing the diagnostic criteria for PTSD as published in the Diagnostic and Statistical manual of mental disorders here.
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least one of the following ways:
Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content
Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
Efforts to avoid thoughts, feelings, or conversations associated with the trauma
Efforts to avoid activities, places, or people that arouse recollections of the trauma
Inability to recall an important aspect of the trauma
Markedly diminished interest or participation in significant activities
Feeling of detachment or estrangement from others
Restricted range of affection (e.g., unable to have loving feelings)
Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Criterion D: hyper-arousal
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hyper-vigilance
Exaggerated startle response
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one month.
Criterion F: functional significance
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
With or without delay onset: Onset of symptoms at least six months after the stressor’(6)
Diagnosing PTSD using DSM-IV:
The DSM-IV criteria requires that the individual must satisfy at least one condition of criterion A i.e. the person must have experienced or witnessed a traumatic event which involved feelings of fear, horror and helplessness. In criterion B from the total of seven a minimum of three symptoms need contentment, whereas criterion C needs only two from its five. If the individual satisfies all three criterions, it confirms the diagnosis of PTSD classified as either acute or chronic based on the duration of symptoms i.e. criterion E.