Susannah L. Mozley
Todd C. Buckley
Danny G. Kaloupek
The current psychiatric nomenclature, as delineated in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994), includes diagnostic criteria for two clinical disorders produced by exposure to traumatic events: acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Unlike most other psychiatric illnesses, these disorders are associated with precipitating events that are a necessary precondition for diagnosis. For an event to be defined as traumatic in this context, it may be directly or indirectly experienced (e.g., witnessed), but it must involve "actual or threatened death or serious injury," and result in a subjective response of "intense fear, helplessness, or horror" (DSM-IV, 1994, pp. 427-428).
Both disorders also require the expression of symptoms characterized as reexperiencing, avoidance, emotional numbing, and heightened arousal. Reexperiencing may include intrusive thoughts about the experience, trauma-related dreams, flashback episodes, a sense of reliving the trauma, or distress when exposed to reminders of the trauma. Avoidance refers to efforts to prevent thinking or speaking about the trauma, which may include involvement in specific behaviors that provide escape from trauma reminders. Numbing symptoms may