Psychiatry

Answer 1 Increased arousal. Many patients with PTSD relive traumatic events through recurrent images, flashbacks (sudden, clear recollection of a traumatic event), nightmares, and increased arousal. A sense of reliving a terrifying experience may cause patients to avoid any stimulus that reminds them of the event. To meet diagnostic criteria for PTSD, patients should have 2 or more persistent symptoms of increased arousal not present before the traumatic event, including difficulty falling asleep or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, or an exaggerated startle response. Additionally, patients with PTSD also can develop dissociative symptoms including derealization (ie, the feeling that the external environment seems unreal or strange), depersonalization (ie, subjective feeling of unreality or strangeness or being disconnected from one’s body or environment), and dissociative amnesia (ie, the inability to recall extensive and important personal information that is usually connected with a traumatic event).1 In PTSD, dissociative amnesia is more extensive than ordinary forgetfulness.1 These dissociative symptoms may also be seen in the context of other illnesses (eg, dissociative fugue, depersonalization disorder).1 Avolition (the lack of interest or desire to pursue goals) is commonly seen in patients with schizophrenia.1 Loss of appetite and crying spells are more commonly present in mood disorders, such as depression and bipolar disorder.1 REFERENCES 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed., text revision. Washington (DC): The Association; 2000:463–86. Click here to return to the questions

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