D. At least two of the following symptoms, which were not present before the trauma:
1. Hyperalertness or exaggerated startle response.
3. Guilt about surviving or about the behavior required to survive.
4. Memory or concentration impairment.
5. Avoidance of activities recalling the event.
6. Intensification of symptoms in circumstances symbolic of the original event.
E. A diagnosis of chronic PTSD is indicated if the symptoms have persisted for over six months, as they have in this case (APA, 1980).
This patient clearly underwent an extraordinary stressor, thus fitting the first criterion (A). She also reported recurring dreams of being attacked (B1) and has acted as if the event were recurring because of an environmental stimulus (B3), i.e. the incident with the residents. The third criterion (reduced responsiveness) is also satisfied because she not only displays sleep disturbances (C2) in the form of insomnia, but also memory trouble (C4) insofar as she cannot recall the actual attack. She also avoids activities evocative of the event (C6), as evidenced by the fact that she is unwilling to return to work, where the attack occurred.
Thus, all of the criteria necessary to make the diagnosis of Chronic PTSD have been satisfied, and it seems plain that this is by far the best diagnosis for this case. It is true that some of the woman's symptoms, if taken out of context, might fit a diagnosis of Adjustment Disorder with Anxious Mood or Withdrawal, or a partial diagnosis of Major Depression. However, none of these diagnoses address all of the woman's symptomology in a fashion as coherent as Chronic Post-Traumatic Stress Disorder.
The second case history describes a 25-year-old man who seeks psychological help because his intense fear of contracting AIDS is interfering with his work and social life. His fear prevents him from going to restaurants, using public bathrooms, or taking any form of publi
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