High scores have been associated with adverse health behaviours and outcomes, including cigarette smoking, coronary artery disease and cancer (Felitti et al., 1998). It can be used to quantify childhood exposure to trauma (although it does not encompass all types of events that would be considered traumatic). The Adverse Childhood Experiences questionnaire (ACE) assesses for seven types of early-life adversity. Given the wide range of experiences that can be considered traumatic, it can be worthwhile to ask a more general question, such as “Have you ever experienced any other difficult event that overwhelmed your ability to cope?” With patients at high risk for occupational exposures to trauma, such as first responders, explore the impact of vicarious exposures. “Have you ever experienced any unwanted sexual contact in childhood or adulthood?”īecause some patients may not identify their experiences as abusive, if you suspect trauma, it can be useful to ask more generally about how “discipline” was handled in the home, or about “early sexual experiences” (Lanius et al., 2016).“Have you ever been exposed to violence as an adult?”.“Was there violence in your home during childhood?”.Ask about personal experiences of abuse, assault or catastrophic events in childhood and adulthood (Lange et al., 2000). The Immigrant and Refugee Mental Health Project: Resources for ProfessionalsĪssess for a history of trauma in all patients presenting with psychiatric complaints.Posttraumatic Stress Disorder: A CAMH Pamphlet.Psychiatry in Primary Care: A Concise Canadian Pocket Guide 2019.Trauma: Health Information for your Patient.Onset prior to traumatic event (APA, 2013).Prominent emptiness and anger, compared with fear, shame and depression in PTSD ( Lanius et al., 2016).
![criteria for ptsd dsm 5 criteria for ptsd dsm 5](https://image1.slideserve.com/1841443/changes-in-criteria-l.jpg)
![criteria for ptsd dsm 5 criteria for ptsd dsm 5](https://image1.slideserve.com/1841443/changes-in-criteria-continued-l.jpg)
The most common comorbidities are mood and anxiety, substance use and dissociative disorders. Up to 80 percent of people with the disorder have an additional psychiatric disorder, which may be the primary complaint or which may emerge upon taking the patient’s history ( Lange et al., 2000). People with PTSD may present in the course of seeking treatment for another psychiatric illness.
![criteria for ptsd dsm 5 criteria for ptsd dsm 5](https://i.pinimg.com/originals/01/db/b3/01dbb352ff8e9c1b8e85c881ba0ef7f5.png)
In general, lack of a temporal relationship between the trauma and the onset or exacerbation of symptoms, as well as the presence of symptoms that are not included in the diagnostic criteria for PTSD, suggest a disorder other than PTSD. Differential DiagnosisĪlthough trauma is relatively common, PTSD is less common. Text adapted from: "The adult patient with posttraumatic stress disorder," in Psychiatry in primary care by Francesca L.