Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) can develop after exposure to traumatic events. Many people experience distress after trauma without developing PTSD. The diagnosis concerns a particular pattern, duration and impact of symptoms, assessed in context. A person's self-description is a starting point for understanding their concerns, not grounds for dismissing them or assuming a diagnosis.
In DSM-5 and DSM-5-TR, PTSD is classified among trauma- and stressor-related disorders. It is no longer grouped with anxiety disorders as it was in DSM-IV. See the National Center for PTSD's account of the DSM criteria.
Video: a brief introduction to PTSD
What is PTSD? — Veterans Health Administration / National Center for PTSD (30 seconds). An accessible introduction to the four broad symptom groups, with a route to further information from the National Center for PTSD. This is general clinical background, not a diagnostic assessment or evidence for IEMT as a PTSD treatment.
Diagnostic Criteria
For adults and children older than six, the DSM framework includes a qualifying exposure to actual or threatened death, serious injury or sexual violence, followed by symptoms across four groups:
| Symptom group | Examples |
|---|---|
| Intrusion | Unwanted memories, nightmares or flashbacks. |
| Avoidance | Avoiding trauma-related thoughts, feelings or reminders. |
| Changes in cognition and mood | Persistent negative beliefs, detachment or reduced interest. |
| Changes in arousal and reactivity | Hypervigilance, exaggerated startle, irritability or sleep difficulties. |
The minimum symptom counts are one intrusion symptom, one avoidance symptom, two cognition/mood symptoms and two arousal/reactivity symptoms. Symptoms must persist for more than a month, cause significant distress or impairment, and not be attributable to a substance or another medical condition. Exposure criteria and exclusions matter; this outline is not a diagnostic checklist. Younger children have a modified set of criteria. See Veterans Affairs Canada's DSM-5-TR criteria set, the National Center for PTSD clinical overview and the wiki's DSM and ICD page.
Complex Post-Traumatic Stress Disorder (CPTSD)
ICD-11 recognises complex PTSD as a distinct diagnosis. It includes the core PTSD features together with persistent difficulties in regulating emotion, a negative sense of self, and difficulties sustaining relationships. DSM-5-TR does not have a separate CPTSD diagnosis. The two classification systems should not be combined into a single checklist.
Prolonged or repeated trauma is relevant to many people's histories, but the label cannot be assigned from the event type alone. The National Center for PTSD's history and definitions of complex PTSD explains the distinction and the development of the concept.
Shell Shock
“Shell shock” was a First World War term covering varied symptoms and explanations. Historical case records cannot all be retrospectively equated with present-day PTSD. The National Archives' War Office report extracts show contemporary uncertainty about causes and classification. A study of Queen Square hospital case records also documents the diversity of presentations.
Historical footage: the existing film is retained as historical context. It is not a demonstration of current diagnostic criteria or evidence that all people shown had the same condition.
Military and Civilian Contexts
PTSD can affect veterans and civilians. Experiences of violence, abuse, disasters and other qualifying events may be relevant. Military service, homelessness or a difficult transition to civilian life is not itself a PTSD diagnosis. Housing needs, physical health, relationships and substance use deserve attention in their own right rather than being attributed automatically to one disorder.
Alcohol and Other Co-occurring Difficulties
PTSD can coexist with depression, anxiety and substance-use disorders. The NIMH PTSD overview discusses these overlapping difficulties. Assessment and planning should consider them together. A single prevalence percentage should not be applied across all populations, settings or definitions of alcohol use.
Treatment and the Place of IEMT
NICE guideline NG116 recommends trauma-focused psychological treatments, including trauma-focused CBT and EMDR under specified circumstances. The recommendations depend on age, timing, symptoms and clinical circumstances. IEMT and EMDR are different approaches; evidence or recommendations for EMDR cannot simply be transferred to IEMT.
This page supplies clinical background, not evidence establishing IEMT as a PTSD treatment. Within the wiki's proposed adaptive formulation framework, record the person's priorities, functioning, existing care, agreed scope and review arrangements. Distinguish a session-level change in distress from a diagnostic conclusion or sustained recovery, and coordinate assessment or referral where the person's needs exceed the practitioner's competence.