National Alliance on Mental Illness
page printed from
(800) 950-NAMI;


The DSM-IV also specifies that the person must experience, witness or be confronted with an event that involves actual or threatened death, serious injury or a threat to their physical integrity (such as rape). This trauma must be severe enough to cause intense fear, helplessness or horror.

Other criteria that help to diagnose PTSD are the reoccurrence of nightmares or frequently having upsetting thoughts or memories regarding the traumatic event. Flashbacks are also common with PTSD along with strong feelings of distress when reminded of the traumatic event.

By creating this narrow definition, the DSM-IV differentiates a diagnosis of PTSD from common everyday experiences that may overwhelm an individual such as feeling “traumatized” by a presentation at work or having to dance in public. The DSM-IV also differentiates PTSD from other conditions involving severe distress.

Though not currently included in the DSM-IV, some researchers have suggested that “complex PTSD” is another variant of the condition. People are thought to develop this condition, which profoundly alters thoughts, emotions and identity, when they are repeatedly subjected to trauma over a long period of time, for example when a person has experienced torture, abduction or other long-term abuse.

PTSD and Co-Occurring Disorders

People who have been traumatized often have conditions that co-occur with PTSD. These conditions can include depression, anxiety, sleep disorders and substance abuse. These associated conditions underscore the importance of getting a comprehensive evaluation and organizing a plan that addresses the individual’s specific concerns. Sleep, in particular, plays an important role in PTSD. There appear to be differences in the way a person in recovering from PTSD enters the Rapid Eye Movement (REM) phase of sleep. These differences may actually be discernible in laboratory testing and help identify the risk for developing this trauma response.

Some people living with PTSD turn to alcohol and drugs in an effort to self-medicate or control the overwhelming feelings resulting from their trauma. Research shows us that among people with lifetime PTSD, approximately 21-43 percent will develop a long-term substance abuse problem, as compared with 8-25 percent of the general population.