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problems at work, in social interactions, and in other important areas of life
( APA, 1994, pp. 427 429 ). The DSM-IV judges the condition to be acute
if it has lasted less than 3 months, and chronic if it has lasted more than 3
months. It is possible for the symptoms to be delayed. The DSM-IV notes
that a diagnosis of delayed onset is given when symptoms begin to show 6
months or more after the original trauma (p. 429).
PTSD is thought to be linked to a highly traumatic experience or
life-threatening event that produces intrusive thoughts related to a very dis-
turbing aspect of the original traumatic event. Those thoughts are difficult to
dislodge once they reach conscious awareness. In many cases of PTSD, the
client physically and emotionally re-experiences the original traumatic event
and is frequently in a highly agitated state of arousal as a result. Symptoms of
PTSD usually begin within 3 months of the original trauma. In half of the
cases of PTSD, complete recovery occurs within 3 months of the onset of
symptoms, but many cases last more than 12 months (APA, 1994, p. 426).
Ozer, Best, Lipsey, and Weiss (2003) describe the symptoms associated with
returning Vietnam veterans that led to a recognition of PTSD as a distinct
diagnostic category: “Intrusive thoughts and images, nightmares, social with-
drawal, numbed feelings, hypervigilance, and even frank paranoia, especially
regarding the government, and vivid dissociative phenomena, such as flash-
backs” (p. 54). The authors believe that the complexity of the symptoms
often led to a misdiagnosis of schizophrenia.
Stein (2002) indicates that an additional symptom of PTSD is physical
pain and writes, “Patients with PTSD are among the highest users of
medical services in primary care settings. Ongoing chronic pain may serve
as a constant reminder of the trauma that perpetuates its remembrance”
(p. 922). Asmundson, Coons, Taylor, and Katz (2002) report that patients
with PTSD present a combination of physical and mental health problems
including increased alcohol consumption and depression. They also indi-
cate that pain is one of the most commonly reported symptoms of
patients with PTSD and write, “patients who have persistent, chronic
pain associated with musculoskeletal injury, serious burn injuries, and
other pathologies (such as fibromyalgia, cancer, or AIDS) frequently pres-
ent with symptoms of PTSD” (p. 930). In a study by White and
Faustman (1989) , 20% of military veterans with PTSD developed chronic
pain. McFarlane, Atchison, Rafalowicz, and Papay (1994) found that vol-
unteer firemen who developed PTSD in response to acts of terrorism and
violence developed a significant amount of pain, primarily back pain, as
compared with 21% of those without symptoms of PTSD.
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