Clinical features

The most characteristic symptoms of PTSD are the re-experiencing symptoms. Patients involuntarily re-experience aspects of the traumatic event in a very vivid and distressing way. This includes: flashbacks in which the person acts or feels as if the event were recurring; nightmares; and intrusive images or other sensory impressions from the event. For example, a women who was assaulted kept seeing the eyes of the perpetrator looking through the letterbox before he broke into her house, and a man involved in a severe car crash at night kept hearing the sound of the impact. Despite these vivid memory fragments, intentional recall of the event is often poor and disorganized, and some patients have amnesia for parts of the event (see also Chapter4.6..3).

Reminders of the trauma arouse intense distress and/or physiological reactions and are consequently avoided, including conversations about the event. Patients try to push memories of the event out of their mind and avoid thinking about the event in detail, particularly about its worst moments. On the other hand, many ruminate excessively about questions that prevent them from coming to terms with the event, for example about why the event happened to them, about how it could have been prevented, or about how they could take revenge.

The patients emotional state ranges from intense fear, anger, sadness, guilt, or shame to emotional numbness. They often describe feeling detached from other people and give up previously significant activities. Various symptoms of hyperarousal include hypervigilance, exaggerated startle responses, irritability, difficulty concentrating, and sleep problems.

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