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Other life stressors, and environmental triggers reminiscent of the trauma, play a central role in determining the severity of current symptoms. The symptoms commonly vary in intensity over time and occasionally present years after the trauma.
An essential requirement for a diagnosis of PTSD is experience of a traumatic event. DSM-IV (summarised in Table 1) emphasises a physical threat, as well as the presence of subjective distress. This latter feature is a matter of controversy because the variability of perception between people exposed to the same event can introduce a person’s premorbid stress reactivity into the aetiological equation.
This is in some conflict with the notion of the stress having the primary role in the diagnosis.
A second group of diagnostic criteria relates to re-experiencing the trauma. Individuals with PTSD remain so captured by the memory of past horror that they have difficulty paying attention to the present. In an attempt to prevent the occurrence of these distressing re-experiencing phenomena, the person is likely to avoid any reminders of the trauma.
In more severe cases, there is a pervasive numbing of general responsiveness to a variety of current life experiences.
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