Anxiety Disorder (V)焦慮症(五): Posttraumatic Stress Disorder:創傷後應激障

A. The person has been exposed to a traumatic event in which both of the following were present:
患者經曆過創傷事件,要有以下兩個方麵的表現:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
患者經曆的,眼見的或者是遭遇到的一起或多起事件,這些事件是死亡,或是對生命安全有威脅,嚴重的創傷,自己或他人身體的完整性受到威脅.

(2) the person’s response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
患者的反應是強烈的害怕,無助,恐懼.注意:對孩子來說,表現可能為強烈的不安.

B. The traumatic event is a persistently experienced in one (or more) of the following ways:
患者持續地經曆這些創傷事件,表現如下:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
這些事件反複地無法擺脫地一再入侵患者的想象,思想或覺知.注意:在兒童,患者在遊戲時反複重複創傷事件的某個重要方麵).

(2) recurrent distressing dreams of the event; Note: In children, there may be frightening dreams without recognizable content.
夢中反複重現創傷事件.注意:在兒童,可能表現為沒有內容的惡夢.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
行動或感覺猶如創傷事件正在發生(包括正生活在創傷事件中,妄想中,錯覺中;清醒或不清醒時刻的不連續的事件回放).注意:在兒童,不自主地重新扮演創傷事件中特定的角色.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
每當暴露在內在的或外在的有關創傷事件的象征時,患者會有強烈的精神痛苦.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
每當暴露在內在的或外在的有關創傷事件的象征時,患者會有身體上的反應.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
患者持續回避與創傷事件有關的刺激,相對於創傷前來說,患者出現感覺麻木,可見以下三或更多狀況:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
努力去回避與創傷有關的思想,感覺,和對話

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
努力去回避會引起與創傷有關回憶的活動,場所,和人.

(3) inability to recall an important aspect of the trauma
不能憶起創傷事件的某個重要方麵.

(4) markedly diminished interest or participation in significant activities
顯著失去興趣或參與某些重要活動

(5) feeling of detachment or estrangement from others
感覺與其他人有隔閡或疏遠

(6) restricted range of affect (e.g., unable to have loving feelings)
情感局限(比如:不能感受到愛)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)感覺前途渺茫(如:不期望有職業前途,有婚姻,孩子,甚至是正常的壽命)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
持續出現一些易於激惹的症狀(創傷事件發生前不存在),可見如下表現:

(1) difficulty falling or staying asleep難於入睡或易醒

(2) irritability or outbursts of anger不安或易怒

(3) difficulty concentrating難於集中注意力

(4) hyper vigilance過於警覺

(5) exaggerated startle response驚嚇反應過度

E. Duration of the disturbance (symptoms in Criteria B, C and D) is more than 1 month.
症狀持續一個月以上

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
患者的症狀達到臨床診斷的顯著痛苦