interviews. However, many epidemiologic studies use screening instruments to assess the number and frequency of symptoms of PTSD, rather than a full diagnostic interview. Those screening instruments include the Department of Veterans Affairs (VA) Primary Care PTSD Screen, the PTSD Checklist (either military or civilian version), the Mississippi Scale for Combat-Related PTSD, and the Keane Scale of the Minnesota Multiphasic Personality Inventory (MMPI-PK).

BOX 5-1

DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder

  1. The person has been exposed to a traumatic event in which both of the following were present:

    1. 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.

    2. The person’s response involved intense fear, helplessness, or horror.

  1. The traumatic event is persistently re-experienced in one (or more) of the following ways:

    1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, and/or perceptions;

    2. Recurrent distressing dreams of the event;

    3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and/or dissociative flashback episodes, including those that occur on awakening or when intoxicated);

    4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event;

    5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

  1. 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:

    1. efforts to avoid thoughts, feelings, and/or conversations associated with the trauma;

    2. efforts to avoid activities, places, and/or people that arouse recollections of the trauma;

    3. inability to recall an important aspect of the trauma;

    4. markedly diminished interest or participation in significant activities;

    5. feeling of detachment or estrangement from others;

    6. restricted range of affect (e.g., inability to have loving feelings);

    7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).

  1. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

    1. difficulty falling or staying asleep;

    2. irritability or outbursts of anger;

    3. difficulty concentrating;

    4. hypervigilance;

    5. exaggerated startle response.

  1. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one (1) month.

  2. The disturbance causes clinically significant distress and/or impairment in social, occupational, and/or other important areas of functioning.

SOURCE: Reprinted with permission from APA (2000).



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