In this paper, I will examine in detail four case histories and seek to make an appropriate diagnosis for each. When more than one diagnosis might be applicable, all alternatives will be explored, and the final decision will be justified through specific matching of reported symptomology with the diagnostic criteria of the DSM-III (APA, 1980).
The first case I will address involves a 30-year-old woman who was raped and beaten by a gang of young men as she was getting into her car after work. Her main symptoms are emotional unresponsiveness, an inability to recall the attack, difficulty falling and remaining asleep, having nightmares about being attacked, loss of interest in her usual leisure activities, refusal to return to work, and an incident in the hospital, in which a group of young residents in her room and she began screaming and begging them not to kill her. Her symptoms began when she was in the hospital after the attack and have continued for the past ten months.
This seems to me to be a clear-cut case of Chronic Post-Traumatic Stress Disorder (PTSD), the essential feature of which is the "development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience." (APA, 1980, p.236). The diagnostic criteria for PTSD are as follows:
A. Existence of an identifiable stressor powerful enough to cause almost anyone distress.
B. Reexperiencing of the trauma, as shown by at least one of the following:
1. Recurrent or intrusive memories of he event.
3. Suddenly acting or feeling like the trauma were recurring, because of an evocative environmental or ideational stimulus.
C. Numbed responsiveness or reduced involvement with the external world beginning after the trauma, as evidenced by at least one of the following:
1. Markedly diminished interest in one or more significant activities.
2. Feeling detached or alienated from others.
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