It is important to understand that people usually cannot make these symptoms disappear just by trying hard to “put the past behind them." The American Psychiatric Association diagnostic manual (DSM-IV) defines Posttraumatic Stress Disorder with specific clinical criteria in order to make a diagnosis:

Criterion A: EXPOSURE TO A LIFE-THREATENING EVENT or one in which there is a threat of serious injury. Whatever causes it, there must be intense fear at the time of the event. This can also include witnessing a violent act or being in a situation of extreme danger.

Criterion B: THE EVENT IS PERSISTENTLY REEXPERIENCED in one of the following specific ways:

(1) distressing memories of the event that intrude suddenly or will not go away;

(2) persistent nightmares;

(3) acting or feeling as if the frightening event is happening all over again, such as with flashbacks or distorted perceptions;

(4) intense mental anguish that is triggered by cues or symbols that mimic some aspect of the original traumatic event;

(5) intense physiological reactivity such as tension or pain also triggered by reminders of the event.

Criterion C: EMOTIONAL NUMBING AND A STRONG TENDENCY TO AVOID TRIGGERS OR REMINDERS in at least three of the following ways:

(1) the person makes efforts to avoid thoughts and feelings related to the trauma (he or she won’t talk about it);

(2) the person avoids activities, people or places that might remind them of the trauma;

(3) the person can’t remember the event or can’t recall aspects of what happened;

(4) the person shows a noticeable loss of interest or participation in significant activities;

(5) he or she has the feeling of being estranged, disconnected or detached from other people;

(6) the person has awkward barriers to the full range of emotions such as an inability to feel affection from another or to have loving feelings;

(7) he or she has a distorted and short view of the future such as not expecting to have a career or normal life span.

Criterion D: PERSISTENT SYMPTOMS OF INCREASED AROUSAL as shown by at least two of the following:

(1) difficulty falling or staying asleep;

(2) outbursts of anger or irritability;

(3) difficulty concentrating;

(4) hypervigilance (scanning the surroundings for possible danger); and

(5) exaggerated startle response.

 Criterion E: THE SYMPTOMS PERSIST FOR MORE THAN ONE MONTH.

Criterion F: THE SYMPTOMS NEGATIVELY IMPACT THE PERSON’S LIFE by causing intense distress or impairment in important areas of living such as the person’s social life, close relationships, school, or work.

This definition of PTSD is very useful as a checklist of symptoms that can arise after an overwhelmingly dangerous event. However, I do not find it very useful in deciding who needs treatment. Apparently, I am not alone. Dr. John Briere, a trauma specialist at USC Medical School once said that the most traumatized individual he had ever treated did not meet the exact criteria for PTSD. The definition is so tightly crafted (by a committee) that many people who suffer intensely from posttraumatic stress end up with another diagnosis that does not highlight the trauma-based roots of the problem.

The real value of the diagnostic criteria is in providing a partial list of trauma-related symptoms. It can be a starting point for understanding what an individual is experiencing. For example, one set of symptoms (Criterion B) involves replaying the tape of the trauma over and over. The next set of symptoms (Criterion C) involves avoiding anything related to the traumatic event. It is as if the brain is moving in opposite directions at the same time.

When you consider the collision of these two brain processes, it’s not hard to see how trauma can be confusing and frustrating.

For our purposes, to understand what causes panic attacks, the key concept here is that reexperiencing traumatic memories can easily precipitate one or more of the symptoms of anxiety attacks.

 

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