For example, if shame is prominent, say, “Many people who have experienced this kind of event feel shame or blame themselves, even though it was not their fault.” How do you think it has affected you? Do you think it is still affecting you now?” Maintain a non-judgmental stance and normalize the wide range of emotions, including shame and numbness.
Do not probe for excessive detail or extensive recounting of memories because it can trigger decompensation.īe attentive to the emotions that may emerge during disclosure, and use validating statements for example, “That sounds like a very difficult experience. Respond sensitively to disclosureĭisclosing a history of trauma can be emotionally evocative, so be careful not to destabilize the patient. The ACE questionnaire is available for free online here. High scores have been associated with adverse health behaviours and outcomes, including cigarette smoking, coronary artery disease and cancer (Felitti et al., 1998). It can be used to quantify childhood exposure to trauma (although it does not encompass all types of events that would be considered traumatic). The Adverse Childhood Experiences questionnaire (ACE) assesses for seven types of early-life adversity. Given the wide range of experiences that can be considered traumatic, it can be worthwhile to ask a more general question, such as “Have you ever experienced any other difficult event that overwhelmed your ability to cope?” With patients at high risk for occupational exposures to trauma, such as first responders, explore the impact of vicarious exposures.
“Was there violence in your home during childhood?”.Ask about personal experiences of abuse, assault or catastrophic events in childhood and adulthood (Lange et al., 2000). The Immigrant and Refugee Mental Health Project: Resources for ProfessionalsĪssess for a history of trauma in all patients presenting with psychiatric complaints.Posttraumatic Stress Disorder: A CAMH Pamphlet.Psychiatry in Primary Care: A Concise Canadian Pocket Guide 2019.Trauma: Health Information for your Patient.Onset prior to traumatic event (APA, 2013).Prominent emptiness and anger, compared with fear, shame and depression in PTSD ( Lanius et al., 2016).Hearing child voices most likely indicates dissociation rather than psychosis ( Dorahy et al., 2009).Greater impairment in reality testing and interpersonal relatedness ( Lanius et al., 2016).Perceptual disturbances not a direct re-experiencing of past trauma.Anxiety content not associated with a specific traumatic event.
Decreased need for sleep (compared with insomnia or sleep disruption in PTSD)Īnxiety Disorders and Obsessive-Compulsive Disorder.Slower mood changes, not linked to traumatic stimuli ( Lanius et al., 2016).Insufficient Criterion B and C symptoms (intrusion and avoidance) to meet full criteria for PTSD.Current episode may be precipitated by Criterion A trauma.May include DSM-5 Criterion D and E symptoms (low mood, social withdrawal, distorted negative cognitions).May meet any or all other PTSD criteria.Involve a stressor, such as job loss, that does not meet Criterion A for PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 APA, 2013).The following section lists disorders that may be confused with PTSD and describes how they differ. The most common comorbidities are mood and anxiety, substance use and dissociative disorders. Up to 80 percent of people with the disorder have an additional psychiatric disorder, which may be the primary complaint or which may emerge upon taking the patient’s history ( Lange et al., 2000). People with PTSD may present in the course of seeking treatment for another psychiatric illness. In general, lack of a temporal relationship between the trauma and the onset or exacerbation of symptoms, as well as the presence of symptoms that are not included in the diagnostic criteria for PTSD, suggest a disorder other than PTSD. Differential DiagnosisĪlthough trauma is relatively common, PTSD is less common. Text adapted from: "The adult patient with posttraumatic stress disorder," in Psychiatry in primary care by Francesca L.