309.81 DSM-IV Criteria for Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following have been 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. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) 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.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) 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 young children, trauma-specific reenactment may occur.

(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.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, 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., unable 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)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

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

F. 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 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Thank you very much.

Yes thanks CV, so much good information.

Yes, I find it strange that very few sources consider enduring and A a possible cause of PTSD. Seems to fit perfectly to me.

"Thank you very much."

No problem Pep! I have always been interested in PTSD and the BS.

"Do you think there is a spectrum of PTSD?

Something like minimal/mild/average/severe/critical ?"

I will be pasting more from the DSM IV which is what is used to make the diagnosis. I think the specifiers might answer that question.

"Do you think PTSD can be the cause of thinking errors?"

I'm definitely not an expert here, but I would say yes. A person gets triggered, immediately starts having thoughts that might be more tied to the past event than the present situation, which then leads to maybe depression, anxiety, etc.

"Yes, I find it strange that very few sources consider enduring and A a possible cause of PTSD. Seems to fit perfectly to me."

I agree. I think unless you've been through this experience, or are a therapist that has dealt with this enough to get it, most people would think comparing a BS to a rape victim ridiculous.

This part of the description really stood out to me.

"The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase."

Think about this. The stressor was of "human design", and it was by the person we loved and trusted. Also, the freaky part for those of us who went through recovery with our FWS, we are in "physical proximity" to our stressor. A rape victim doesn't have to be around the rapist. Interesting, isn't it. I'll copy the rest of the criteria on another post for those of you who are interested.

309.81 Posttraumatic Stress Disorder


Diagnostic Features

The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).

Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.

The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for a woman who was raped in an elevator).

Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situation, or people who arouse recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).

The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3).

Specifiers

The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder:

Acute. This specifier should be used when the duration of symptoms is less than 3 months.
Chronic. This specifier should be used when the symptoms last 3 months or longer.
With Delayed Onset. This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.

Associated Features and Disorders

Associated descriptive features and mental disorders. Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job. The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e.g., childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture): impaired complaints; feelings of ineffectiveness, shame, despair, or hopelessness; feeling permanently damaged; a loss of previously sustained beliefs, hostility; social withdrawal; feeling constantly threatened; impaired relationships with others; or a change from the individual's previous personality characteristics.

There may be increased risk of Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Social Phobia, Specific Phobia, Major Depressive Disorder, Somatization Disorder, and Substance-Related Disorders. It is not known to what extent these disorders precede or follow the onset of Posttraumatic Stress Disorder.

The DSM-IV (and soon, the DSM-V) are the clinical "Bibles" for counselors and helping professionals. It takes quite a bit of study to get a full appreciation of its contents (and not a little background knowledge to understand the process by which a condition is listed. NB: There is talk that Borderline Personality Disorder may be renamed Emotional Disregulation Disorder in the DSM-V).

For a more layman's description, I like several web sites and have found the Real Mental Health site to be a good resources.

Here is the page that describes PTSD.

This applies to so many BS's I can think of, thanks for posting it, CV55. It is heartbreaking. Here is something Dr. Harley wrote over on the weekend board about why he developed Plan B:

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I think this is the URL you wanted.

Mel, I think it was you who wrote recently that you knew you didn't have the stomach for Plan A. I can honestly say that Plan A was one of the most difficult things I've ever had to do. I totally agree with Dr. Harley. In our case H did fire OW immediately but she worked with him for another month, and then I think it was about another month of phone and one contact before NC began. Still, a BS has to do the whole Plan A thing while their crazy-A$$ WS is defogging. It's so humiliating. Being with your S "the stressor" that you know is grieving for the person who helped mow down your life. I was both a good Plan Aer, and then as SD used to call me, a Black Mamba. The Black Mamba kept me sane. Going through that once I would never do that again. If H ever betrayed me again, and I was even contemplating staying and Plan Aing, I'm hoping somebody will shoot me first.

I've had a some non-A related traumas. 3 that I can think of off the top of my head.

1. I was aboard a sailboat when a huge wave hit, and the boat capsized.
When the boat finally righted it's self, I was still on board, but I was alone, everyone else was in the ocean. The tiller had broken off, the mast was bent, and there were more waves about to strike broadside. There was no way to steer/control the boat. One of the people in the water was in his 60's, was post heart-valve surgery on coumadin, and was very weak. The coast guard rescued us.

2. I was in my compact car when a huge semi truck suddenly swerved and struck my car, sending it spinning across 4 lanes of traffic, and my car was struck twice more by other vehicles. 6 vehicles were involved. No fatalities.

3. I was being prepped for surgery. The anesthesiologist made a drug error, IV pushed a neuromuscular-blocking drug (causes skeletal muscle paralysis) while I was still awake. This meant that I was completely conscious, while I was unable to breathe, move, or speak. I could hear and feel the staff doing resuscitation on me.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Trauma responses:

#1. I was able to quickly return to sailing, albeit with some level of trepidation and fear of the ocean. I like to call it "respect for mother nature".

#2. For years, my heart would race whenever a large truck was next to my vehicle. I would make driving maneuvers to avoid being in a lane next to a truck. The panic feeling was a hundred times worse if I was not driving. It still bothers me to this day .... but not too much. (the MVA was 30 years ago !)

#3. For approximately a year, I had nightmares that I could not breathe. This particular trauma is completely benign to me now.

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Now, on to the A related trauma.

It was discovered in 1985.
It caused severe physical symptoms. Much worse than any of the previous, described above.
Weight loss of 25 pounds.
Sleep disorder.
Mood disorder.
Thought disorder.
It required counseling, medication, prayer, and lot of effort on my part, to recover.

But, I did

I can honestly say the A was by far much more like PTSD than any previous experience.
For me, anyway.

Your post rings so true with me 'Pep'. I get so frustrated when my FWW tries to down play her A's, or to minimize them. She will throw out things like how I am not the only victim here, (I've never used the word victim ever), or how she was feeling the same hurt back when she was doing the A's as I am feeling now, post Dday, (that one really rips me).

Two of the biggest trauma events in my life, besides my wifes A's, were the loss of two children. We lost one the day after he was born, (David, 1991), and one child 7 months after she was born, (Erin, 1996). Needless to say they were terrible times in our lives, but my wifes A's are the worst pain I've felt in my life.

Pep wrote:

"I can honestly say the A was by far much more like PTSD than any previous experience.
For me, anyway."

After Hurricane Katrina I wrote a post on Recovery comparing As to the devastation of that hurricane. I think it was in that thread that a male poster, I'm not sure who, said he had been in a war, witnessed the death of a very young person during the war, and had experienced the death of a child and none of those things caused him more pain than his W's A.

codtej wrote:

"Your post rings so true with me 'Pep'. I get so frustrated when my FWW tries to down play her A's, or to minimize them. She will throw out things like how I am not the only victim here, (I've never used the word victim ever), or how she was feeling the same hurt back when she was doing the A's as I am feeling now, post Dday, (that one really rips me)."

Your W will never know what your feeling. It's like trying to explain what it's like experiencing a death to someone who has never lost anyone. Just hold your ground and hopefully in time she will at least have empathy.

All the desriptions of PTSD fit me perfectly. I have never experienced PTSD before but I know for a d*mn straight fact that the A has caused PTSD in me.

How long until it began to go away for you, Pep?