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Section 3: Overview of trauma symptoms

3.1 Trauma as defined by the DSM 5 (2013)

The American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD is included in a new category in DSM-5, trauma- and stressor-related disorders.

DSM-5 Criteria to diagnose someone with PTSD is summarised as follows (Please note that as a community art counsellor you are not allowed to diagnose any disorder):

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):

  • Intrusive thoughts
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behaviour
  • Hyper-vigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F (required): Symptoms last for more than one month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

DSM-5 criteria for PTSD in children aged 6 years or younger are as follows:

  • Directly experiencing the traumatic event, witnessing the event, or learning it occurred to a parent or caregiver.
  • Intrusion symptoms associated with the event (recurrent memories, distressing dreams, dissociative reactions, marked distress or physiological reaction in response to exposure to traumatic triggers).
  • Avoidance of situations or things that arouse recollections of the trauma or negative alterations in cognitions (increased negative emotions, decreased interest in significant activities, social withdrawal, decreased positive emotions).
  • Alterations in arousal and reactivity associated with the traumatic events (two of irritability, hypervigilance, exaggerated startle, concentration problems, sleep disturbance).
  • Duration of the disturbance exceeding 1 month.
  • Clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or in school behaviour.
  • Inability to attribute the disturbance to the physiologic effects of a substance or another medical condition.
What types of trauma do young children experience?

Young children are exposed to many types of traumatic experiences, placing them at risk for PTSD. These can include:

  • Abuse
  • Witnessing interpersonal violence
  • Motor vehicle accidents
  • Experiences of natural disasters
  • Conditions of war
  • Dog bites
  • Invasive medical procedures
How is the diagnosis different in preschool PTSD? 

Because young children have emerging abstract cognitive and verbal expression capacities, research has shown that the criteria need to be more behaviourally anchored and developmentally sensitive to detect PTSD in preschool children.

3.2  Experiential creative experience on beginning to work with trauma

Now that you have some knowledge of trauma from a variety of theoretical perspectives we are going to use this foundation to build a set of tools and techniques to assist clients to process and manage both traumatic symptoms as well as the meaning associated with the trauma.

The activities in this module are divided into themes to link specific aspects of trauma work to a specific activity. The themes are: safety; grounding; the effect of stress on the body, its impact on cognition (thought) and the behavioural manifestations; the overlap between the symbolic and neuroscience; technique to manage triggers once back in the world;

A. Theme: Safety

 

B. Theme: Grounding 

C. Theme: The effect of stress on the body, its impact on cognition (thought) and the behavioural manifestations

D. Theme: The overlap between the symbolic and neuroscience

 

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