Individuals with PTSD may be quick tempered and may even engage in aggressive verbal and / or physical behavior with little or no provocation (e.g., yelling at people, get- ting into fights, destroying objects) (Criterion E1). They may also engage in reckless or self- destructive behavior such as dangerous driving, excessive alcohol or drug use, or self- injurious or suicidal behavior (Criterion E2). PTSD is often characterized by a heightened sensitivity to potential threats, including those that are related to the traumatic experience (e.g., following a motor vehicle accident, being especially sensitive to the threat potentially caused by cars or trucks) and those not related to the traumatic event (e.g., being fearful of suffering a heart attack) (Criterion E3). Individuals with PTSD may be very reactive to un- expected stimuli, displaying a heightened startle response, or jumpiness, to loud noises or unexpected movements (e.g., jumping markedly in response to a telephone ringing) (Cri- terion E4). Concentration difficulties, including difficulty remembering daily events (e.g., forgetting one’s telephone number) or attending to focused tasks (e.g., following a conver- sation for a sustained period of time), are commonly reported (Criterion E5). Problems with sleep onset and maintenance are common and may be associated with nightmares and safety concerns or with generalized elevated arousal that interferes with adequate sleep (Criterion E6). Some individuals also experience persistent dissociative symptoms of de- tachment from their bodies (depersonalization) or the world around them (derealization); this is reﬂected in the ”with dissociative symptoms” specifier.
Developmental regression, such as loss of language in young children, may occur. Audi— tory pseudo-hallucinations, such as having the sensory experience of hearing one’s thoughts spoken in one or more different voices, as well as paranoid ideation, can be pres- ent. Following prolonged, repeated, and severe traumatic events (e.g., childhood abuse, torture), the individual may additionally experience difficulties in regulating emotions or maintaining stable interpersonal relationships, or dissociative symptoms. When the trau- matic event produces violent death, symptoms of both problematic bereavement and PTSD may be present.
In the United States, projected lifetime risk for PTSD using DSM-IV criteria at age 75 years is 8.7%. Twelve—month prevalence among U.S. adults is about 3.5%. Lower estimates are seen in Europe and most Asian, African, and Latin American countries, clustering around 0.5"o—1.0%. Although different groups have different levels of exposure to traumatic events, the conditional probability of developing PTSD following a similar level of expo- sure may also vary across cultural groups. Rates of PTSD are higher among veterans and others whose vocation increases the risk of traumatic exposure (e.g., police, firefighters, emergency medical personnel). Highest rates (ranging from one-third to more than one— half of those exposed) are found among survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide. The prevalence of PTSD may vary across development; children and adolescents, including preschool children, generally have displayed lower prevalence following exposure to serious traumatic events; however, this may be because previous criteria were insufficiently developmen- tally informed. The prevalence of full-threshold PTSD also appears to be lower among older adults compared with the general population; there is evidence that subthreshold presentations are more common than full PTSD in later life and that these symptoms are associated with substantial clinical impairment. Compared with US. non-Latino whites, higher rates of PTSD have been reported among US. Latinos, African Americans, and
American Indians, and lower rates have been reported among Asian Americans, after ad- justment for traumatic exposure and demographic variables.