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Module 1: Trauma, Recovery and Torture Survivors

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening
after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia
and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am
bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently
ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the
individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or
loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening
after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical
aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or
another medical condition.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder,
and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either
of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an
outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a
sense of unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around
the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the
dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts,
behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
Specify whether:
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although
the onset and expression of some symptoms may be immediate).
—American Psychiatric Association, 2013

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