Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).
Specify it:
With delayed expression: It the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
The essential feature of posttraumatic stress disorder (PTSD) is the development of char- acteristic symptoms following exposure to one or more traumatic events. Emotional re- actions to the traumatic event (e.g., fear, helplessness, horror) are no longer a part of
Criterion A. The clinical presentation of PTSD varies. In some individuals, fear-based re- experiencing, emotional, and behavioral symptoms may predominate. In others, anhe- donic or dysphoric mood states and negative cognitions may be most distressing. In some other individuals, arousal and reactive-externalizing symptoms are prominent, while in others, dissociative symptoms predominate. Finally, some individuals exhibit combina- tions of these symptom patterns.
The directly experienced traumatic events in Criterion A include, but are not limited to, exposure to war as a combatant or civilian, threatened or actual physical assault (e.g., physical attack, robbery, mugging, childhood physical abuse), threatened or actual sexual violence (e.g., forced sexual penetration, alcohol/drug-facilitated sexual penetration, abu- sive sexual contact, noncontact sexual abuse, sexual trafficking), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or hu- man-made disasters, and severe motor vehicle accidents. For children, sexually violent violence or injury. A life-threatening illness or debilitating medical condition is not neces- sarily considered a traumatic event. Medical incidents that qualify as traumatic events in- volve sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock).
Witnessed events include, but are not limited to, observing threatened or serious injury, unnatural death, physical or sexual abuse of another person due to violent assault, domes- tic violence, accident, war or disaster, or a medical catastrophe in one’s child (e.g., a life- threatening hemorrhage). Indirect exposure through learning about an event is limited to experiences affecting close relatives or friends and experiences that are Violent or acciden- tal (e.g., death due to natural causes does not qualify). Such events include violent per- sonal assault, suicide, serious accident, and serious injury. The disorder may be especially severe or long-Iasting when the stressor is interpersonal and intentional (e.g., torture, sex- ual violence).