Post-traumatic stress disorder: diagnosis

Post-traumatic stress disorder ( PTSD ) means a delayed or prolonged reaction to a major stress or threat. In addition, there is a possibility that after repeated or persistent extreme stress (e.g. physical or sexual abuse in childhood, or torture) a permanent change in personality will occur.

Post-traumatic stress disorder : what is it?

Manifestations of this disorder were first described in connection with the experiences of people who found themselves in the middle of a war conflict. Post-traumatic stress disorder or PTSD (the abbreviation comes from the English term post -traumatic stress disorder ) can occur after situations of extraordinary threat (e.g. war, terrorist attacks, serious injuries, violence) or after changes of a catastrophic scale (e.g. natural disasters). These events cause severe upset in (almost) everyone. Added to this are various symptoms, such as, in particular, re-experiencing the traumatic event in thoughts or dreams (so-called flashbacks), excessive irritability and avoidance behavior.

Intense reactions can also occur directly during or immediately after the trauma . They include:

• the feeling that the person himself, the things around him or his experiences are not real (derealization),
• the feeling that one is not oneself (depersonalization),
• change in perception and experience of time.

One can also feel mentally absent and “empty” (without feelings). In this context, we are talking about the so-called symptoms of dissociation. There may also be strong feelings of guilt and shame, often significant mood swings.

Symptoms (not necessarily all) may appear immediately after the traumatic event and usually resolve within 4-8 weeks. We only talk about post-traumatic stress disorder if the symptoms persist eight weeks after the traumatic event.

However, sometimes there is also a delayed reaction, i.e. symptoms appear only after a longer period of time has passed since the traumatic event. If this happens after six months or later, it is called chronic post-traumatic stress disorder .

How is PTSD diagnosed ?

If post-traumatic stress disorder (PTSD) is suspected, the sufferer should first talk confidentially with a doctor or psychotherapist . During this interview, the specialist takes an anamnesis (i.e. asks about the illnesses experienced so far), sensitively inquires about the circumstances of the traumatic event and finds out the symptoms. Sometimes standardized questionnaires are also used. The doctor may also send the affected person for some other examinations in order to rule out physical or other diseases. Typically, this involves a neurological examination or some imaging tests (e.g. magnetic resonance imaging ) if the victim has also suffered an injury (e.g. head). Sufferers often experience physical pain as well; in this case, it is necessary to clarify whether or not these pains have an organic cause.

Main symptoms of PTSD

Diagnostic criteria are described in the International Classification of Diseases ( ICD-10 ) and in DSM-5 (guidelines published by the American Psychiatric Association in 2013). These classification systems are partially different from each other. In the Czech Republic, ICD-10 is used for diagnosis. According to the International Classification of Diseases, post-traumatic stress disorder is characterized by the following symptoms:

• the affected person was exposed to an event or situation (of short or long duration) of an extremely threatening or catastrophic nature; such an event or situation would cause deep despair in almost any person,
• the sufferer has flashbacks (reliving the traumatic event in persistent and intrusive memories), vivid memories and recurring nightmares,
• avoiding situations that resemble or have some connection with the traumatic event.

Other possible symptoms of PTSD

In addition, the following symptoms may occur:

• memory lapses in connection with a traumatic event,
• increased irritability and sensitivity, together with the following symptoms: falling asleep and sleeping disorders, irritability, outbursts of anger, increased irritability, impaired concentration, increased vigilance (the affected person is constantly “on alert”).

In connection with a traumatic event, the sufferer may experience thought or emotional reactions (e.g. anxiety, helplessness) that are very burdensome for him. A very significant factor in the development of PTSD is the feeling of loss of control.

The symptoms described above may not always develop fully. Just because someone outwardly appears mentally stable after a trauma does not mean they will not develop PTSD.

Who can I contact?

If you suspect that you are suffering from the consequences of mental trauma , you can contact an expert from one of the health professions or institutions listed below. While doing so, try to find out if he specializes in mental trauma:

• psychiatrist,
• psychotherapist,
• clinical psychologist ,
• crisis center (e.g. Crisis Center of the Psychiatric Clinic of the Brno University Hospital [1]),
• ambulance of psychiatry, psychosomatics , or psychotherapy.