|The ICD-10 Classification of Mental and Behavioural
World Health Organization, Geneva, 1992
F43.1 Post-Traumatic Stress Disorder
This arises as a delayed and/or protracted response to a
stressful event or situation (either short- or long-lasting) of an
exceptionally threatening or catastrophic nature, which is likely
to cause pervasive distress in almost anyone (e.g. natural or
man-made disaster, combat, serious accident, witnessing the
violent death of others, or being the victim of torture,
terrorism, rape, or other crime).
Predisposing factors such as personality traits (e.g.
compulsive, asthenic) or previous history of neurotic illness may
lower the threshold for the development of the syndrome or
aggravate its course, but they are neither necessary nor
sufficient to explain its occurrence.
Typical symptoms include episodes of repeated reliving of the
trauma in intrusive memories ("flashbacks") or dreams,
occurring against the persisting background of a sense of
"numbness" and emotional blunting, detachment from other
people, unresponsiveness to surroundings, anhedonia, and avoidance
of activities and situations reminiscent of the trauma. Commonly
there is fear and avoidance of cues that remind the sufferer of
the original trauma. Rarely, there may be dramatic, acute bursts
of fear, panic or aggression, triggered by stimuli arousing a
sudden recollection and/or re-enactment of the trauma or of the
original reaction to it.
There is usually a state of autonomic hyperarousal with
hypervigilance, an enhanced startle reaction, and insomnia.
Anxiety and depression are commonly associated with the above
symptoms and signs, and suicidal ideation is not infrequent.
Excessive use of alcohol or drugs may be a complicating factor.
The onset follows the trauma with a latency period which may
range from a few weeks to months (but rarely exceeds 6 months).
The course is fluctuating but recovery can be expected in the
majority of cases. In a small proportion of patients the condition
may show a chronic course over many years and a transition to an
enduring personality change.
This disorder should not generally be diagnosed unless there is
evidence that it arose within 6 months of a traumatic event of
exceptional severity. A "probable" diagnosis might still
be possible if the delay between the event and the onset was
longer than 6 months, provided that the clinical manifestations
are typical and no alternative identification of the disorder
(e.g. as an anxiety or obsessive-compulsive disorder or depressive
episode) is plausible. In addition to evidence of trauma, there
must be a repetitive, intrusive recollection or re-enactment of
the event in memories, daytime imagery, or dreams. Conspicuous
emotional detachment, numbing of feeling, and avoidance of stimuli
that might arouse recollection of the trauma are often present but
are not essential for the diagnosis. The autonomic disturbances,
mood disorder, and behavioural abnormalities all contribute to the
diagnosis but are not of prime importance.
The late chronic sequelae of devastating stress, i.e. those
manifest decades after the stressful experience, should be
classified under F62.0.
* traumatic neurosis
ICD-10 copyright © 1992 by World Health Organization.
Psychiatry copyright © (www.azpsychiatry.info)
by Dr. Manaan Kar Ray