american psychiatric association. diagnostic and statistical manual of mental disorders, 4th ed....
DESCRIPTION
DSM-IV Diagnostic Criteria for PTSD Avoidance/Numbing Avoidance of stimuli and numbing of general responsiveness indicated by 3 of the following: –avoid thoughts, feelings, or conversations* –avoid activities, places, or people* –inability to recall part of trauma – interest in activities –estrangement from others –restricted range of affect –sense of foreshortened future American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edTRANSCRIPT
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994.
DSM-IV Diagnostic Criteria for PTSD• Exposure to a traumatic event in which the person:
– experienced, witnessed, or was confronted by death or serious injury to self or others AND
– responded with intense fear, helplessness, or horror• Symptoms
– appear in 3 symptom clusters: re-experiencing, avoidance/numbing, hyperarousal
– last for > 1 month– cause clinically significant distress or impairment in functioning
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders,4th ed. 1994.
DSM-IV Diagnostic Criteria for PTSD Re-experiencing
• Persistent re-experiencing of 1 of the following:– recurrent distressing recollections of event– recurrent distressing dreams of event– acting or feeling event was recurring– psychological distress at cues resembling event– physiological reactivity to cues resembling event
DSM-IV Diagnostic Criteria for PTSD Avoidance/Numbing
• Avoidance of stimuli and numbing of general responsiveness indicated by 3 of the following:– avoid thoughts, feelings, or conversations*– avoid activities, places, or people*– inability to recall part of trauma interest in activities– estrangement from others– restricted range of affect– sense of foreshortened future
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994.
DSM-IV Diagnostic Criteria for PTSD Hyperarousal
• Persistent symptoms of increased arousal 2:– difficulty sleeping– irritability or outbursts of anger– difficulty concentrating– hypervigilance– exaggerated startle response
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994.
Kessler R et al. J Clin Psychiatry. 2000;61(Suppl 5):4-14. Kessler R et al. Arch Gen Psychiatry. 1995;52:1048-1060.
Prevalence of Trauma and Probability of PTSD
Probability of PTSD
010203040506070
Witness Accident Threat w/Weapon
PhysicalAttack
Molestation Combat Rape
%
Prevalence of Trauma
0
10
20
30
40
%
MaleFemale
Witness Accident Threat w/Weapon
PhysicalAttack
Molestation Combat Rape
1
2
12
Lifetime Prevalence of PTSD in the Community
5% LifetimePrevalence for Men
10.4% LifetimePrevalence for Women
Estimated LifetimePrevalence of PTSD = 7.8%
Kessler R et al. Arch Gen Psychiatry. 1995; 52:1048-1060.
0
25
50
75
100
Vitality Social Function
PTSDMDDOCDUS Population
Impaired Quality of Life with PTSD
SF-36 = 36 item short form health surveyLower score = more impairmentMalik M et al. J Trauma Stress. 1999;12:387-393.
SF-36 Score
1Kessler R et al. J Clin Psychiatry. 2000; 61 (Suppl 5): 4-12. 2Kessler R et al. Am J Psychiatry. 1999;156:115-123.
• Average work loss = 3.6 days/month1
• Annual productivity loss = $ 3 billion1
• Medical utilization: mean number of past year general medical visits2 – PTSD 5.3– Any anxiety disorder 4.4– Major depression 3.4
Economic Burden of PTSD
Agoraphobia
0
10
20
30
40
50
60 MalesFemales
Com
orbi
dity
(%)
Psychiatric Comorbidity in PTSD
Major Depressive
Episode
GAD Panic Disorder
Social Anxiety Disorder
AlcoholAbuse/
Dependence
DrugAbuse/
Dependence
Kessler R et al. Arch Gen Psychiatry. 1995; 52:1048-1060.