Many of the clients we worked with in our private practice had sub-clinical symptoms trauma but not enough to make a diagnosis of PTSD. These clients also were struggling in sustaining intimate relationships and with the kinds of behavioral patterns typically associated with trauma. When we reviewed their intake histories, however, we found that very few of them had experienced extreme or unusual events in their lives that would account for these symptoms. So we began looking at their very early relational histories for more subtle relational events that might account for the presence of these symptoms. We asked them to interview their parents, siblings, extended families and neighbors to get more information about this period of their lives.
The information that many of these clients discovered about their birth and the first three years of their lives revealed high levels of unrecognized and untreated trauma. This deeper investigation into their histories helped us understand why they displayed so many of the symptoms of PTSD, and was an important step in our discovery of developmental trauma.
The criteria for making a diagnosis of PTSD are identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV.) It defines PTSD as a set of behaviors resulting from exposure to a traumatic event and involving any of the following conditions:
- 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.
- The person has intense fear, helplessness, or horror. In children this can be expressed as disorganized or agitated behavior.
- The person has clinically significant distress and impairment in social, occupational or other important areas of functioning.
Vicarious traumatization occurs when a person witnesses the serious injury or death of others. PTSD can be categorized as acute, delayed, chronic or intermittent/recurrent. The standard clinical symptoms of PTSD, taken from the DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders (1994) Include: Re-experiencing the traumatic event in one of the following ways:
- Sudden flashbacks of memory of the trauma at unexpected and unwelcome times.
- Enduring memories of the traumatic event or events.
- Recurrent distressing dreams or nightmares about traumatic events.
- Suddenly feeling that the event is happening now.
- Intense distress when exposed to events that symbolize or resemble a part of the original event.
Avoidance of things that remind one of the traumatic event or a general numbing reaction. This symptom can include:
- Compulsive efforts to avoid thoughts or feelings of the trauma
- Compulsive efforts to avoid activities or situations that remind one of the trauma
- Amnesia for an important part of the trauma
- Marked disinterest in work, relationships or recreations
- Feelings of detachment or estrangement from others
- A restricted range of feelings, including anger and love
- A sense of doom about the future
Hyperarousal symptoms as evidenced by any of the following:
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
- Physical symptoms such as vomiting, nausea or increased pulse rate
These behavioral descriptors have been gathered and systematized by mental health professionals and organized into a manual compiled by the American Psychiatric Association the Diagnostic and Statistical Manual. Mental health professionals use this DSM to identify and diagnose mental illnesses. As developmental psychologists, we believe that the DSM is really a manual that examines the impact of developmental shock, trauma and stress on humans. We’ve created a self-inventory that you can use to determine if you have symptoms of PTSD Download PTSD Inventory