dsmv notes on trauma

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Negative alterations in cognitions or mood associated with the event begin or worsen after exposure to the event. These negative alterations can take various forms, including an inability to remember an important aspect of the traumatic event; such amnesia is typically
due to dissociative amnesia and is not due to head injury, alcohol, or drugs (Criterion Dl).
Another form is persistent (i.e., always or almost always) and exaggerated negative expectations
regarding important aspects of life applied to oneself, others, or the future (e.g.,
"I have always had bad judgment"; "People in authority can't be trusted") that may manifest
as a negative change in perceived identity since the trauma (e.g., "I can't trust anyone
ever again"; Criterion D2). Individuals with PTSD may have persistent erroneous cognitions
about the causes of the traumatic event that lead them to blame themselves or others
(e.g., "It's all my fault that my uncle abused me") (Criterion D3). A persistent negative
mood state (e.g., fear, horror, anger, guilt, shame) either began or worsened after exposure
to the event (Criterion D4). The individual may experience markedly diminished interest
or participation in previously enjoyed activities (Criterion D5), feeling detached or estranged
from other people (Criterion D6), or a persistent inability to feel positive emotions
(especially happiness, joy, satisfaction, or emotions associated with intimacy, tenderness,
and sexuality) (Criterion D7).

Individuals with PTSD may be quick tempered and may even engage in aggressive
verbal and/or physical behavior with little or no provocation (e.g., yelling at people, getting
into fights, destroying objects) (Criterion El). They may also engage in reckless or self destructive behavior such as dangerous driving, excessive alcohol or drug use, or self injurious
or suicidal behavior (Criterion E2). PTSD is often characterized by a heightened
sensitivity to potential threats, including those that are related to the traumatic experience
(e.g., following a motor vehicle accident, being especially sensitive to the threat potentially
caused by cars or trucks) and those not related to the traumatic event (e.g., being fearful of
suffering a heart attack) (Criterion E3). Individuals with PTSD may be very reactive to unexpected stimuli, displaying a heightened startle response, or jumpiness, to loud noises or
unexpected movements (e.g., jumping markedly in response to a telephone ringing) (Criterion
E4). Concentration difficulties, including difficulty remembering daily events (e.g.,
forgetting one's telephone number) or attending to focused tasks (e.g., following a conversation
for a sustained period of time), are commonly reported (Criterion E5). Problems
with sleep onset and maintenance are common and may be associated with nightmares
and safety concerns or with generalized elevated arousal that interferes with adequate sleep
(Criterion E6). Some individuals also experience persistent dissociative symptoms of detachment
from their bodies (depersonalization) or the world around them (derealization);
this is reflected in the ''with dissociative symptoms" specifier.