When Do the Effects of Trauma Cross the Line into PTSD?


Not all trauma leads to the development of Post-Traumatic Stress Disorder (PTSD). Learn specific criteria to help you identify PTSD in you or a family member.

Today, we’ll look at the specific criteria for the syndrome we describe as Post-Traumatic Stress Disorder (PTSD).

Not all trauma leads to the development of Post-Traumatic Stress Disorder (PTSD).

When we use the term PTSD, we refer to a clinical syndrome resulting from exposure to actual (or threatened death), serious injury or sexual violence that…

  • is directly experienced
  • is witnessed, in person, the event(s) as it occurred to others
  • follows learning the event(s) occurred to a close family member or friend
  • occurs after experiencing repeated or extreme exposure to aversive details of traumatic events

PTSD is characterized by “intrusion symptoms” associated with the traumatic event, beginning after the traumatic event, including…

  • recurrent, involuntary and intrusive distressing memories
  • recurrent, distressing dreams
  • flashbacks (dissociative reactions in which the person responds as if the traumatic event is recurring
  • intense, prolonged psychological distress, or marked physiologic reaction upon exposure to internal or external cues associated with the event

PTSD is also characterized by persistent avoidance of stimuli associated with the traumatic event, including distressing thoughts, memories, feelings and distressing reminders of the event.

Children and adults with PTSD experience negative alterations in cognition and mood associated with the traumatic event, including at least two of the following symptoms…

  • inability to remember some important aspect of the traumatic event
  • persistent, exaggerated negative beliefs or expectations about oneself, others or the world
  • distorted cognitions about the cause(s) of the traumatic event, leading to self-blame
  • persistent, negative emotional states (fear, horror, anger, guilt, shame)
  • markedly diminished interest or participation in significant activities
  • detachment or estrangement from others
  • persistent inability to experience positive emotions

Persons with PTSD experience marked increases in arousal and reactivity associated with the traumatic event, as characterized by two or more of the following…

  • verbal and/or physical aggression toward people or objects
  • reckless, self-destructive behavior
  • hypervigilance
  • exaggerated startle response
  • difficulties with concentration
  • disturbed sleep

By definition, symptoms must persist for more than one month following the traumatic event in question and result in significant functional impairment.

Developmental regression is common in children with PTSD. Young children are more likely to manifest re-experiencing symptoms through play that refers directly or symbolically to the traumatic event. Persons with PTSD are 80% more likely than those without PTSD to have at least one or more “comorbid” disorders…kids with PTSD are more likely to have Oppositional Defiant Disorder and Separation Anxiety Disorder, males with PTSD are more likely to have concomitant substance use disorders and Conduct Disorder, with depressive, bipolar, anxiety and substance use disorders occurring more commonly among adults with PTSD.

Dr. Steve Grcevich is a physician specializing in child and adolescent psychiatry who serves as President and Founder of Key Ministry. He blogs at church4everychild.org and may be reached at steve@keyministry.org.


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