Health Impacts of Violent Victimization on Women and their Children

Appendix 1: Definitions of Mental Health Disorders (from DSM-IV)

Post-traumatic Stress Disorder (PTSD)

Category: Anxiety Disorders

By definition, PTSD always follows a traumatic event which causes intense fear and/or helplessness in an individual. Typically the symptoms develop shortly after the event, but may take years. The duration for symptoms is at least one month for this diagnosis.

Symptoms include re-experiencing the trauma through nightmares, obsessive thoughts, and flashbacks (feeling as if you are actually in the traumatic situation again). There is an avoidance component as well, where the individual avoids situations, people, and/or objects which remind him or her about the traumatic event (e.g., a person experiencing PTSD after a serious car accident might avoid driving or being a passenger in a car). Finally, there is increased anxiety in general, possibly with a heightened startle response (e.g., very jumpy, startle easy by noises).

Prognosis ranges from moderate to very good. Those with the best prognosis include situations where the traumatic event was acute or occurred only one time (e.g., car accident) rather than chronic, or on-going trauma (e.g., ongoing sexual abuse, war).

Major Depressive Disorder (Unipolar Depression)

Category: Mood Disorders

Research has shown that depression is influenced by both biological and environmental factors. Studies show that first degree relatives of people with depression have a higher incidence of the illness, whether they are raised with this relative or not, supporting the influence of biological factors. Situational factors, if nothing else, can exacerbate a depressive disorder in significant ways. Examples of these factors would include lack of a support system, stress, illness in self or loved one, legal difficulties, financial struggles, and job problems. These factors can be cyclical in that they can worsen the symptoms and act as symptoms themselves.

Symptoms of depression include the following:

  • depressed mood (such as feelings of sadness or emptiness)
  • reduced interest in activities that used to be enjoyed, sleep disturbances (either not being able to sleep well or sleeping to much)
  • loss of energy or a significant reduction in energy level
  • difficulty concentrating, holding a conversation, paying attention, or making decisions that used to be made fairly easily
  • suicidal thoughts or intentions.

Major Depressive Disorder has a better prognosis than other mood disorders in that medication and therapy have been very successful in alleviating symptomotology. However, many people with this disorder find that it can be episodic, in that periodic stressors can bring back symptoms. In this case, it is often helpful to have an ongoing relationship with a mental health professional just as you would a physician if you had diabetes or high blood pressure.

Substance Abuse

Category: Substance Related Disorders

There is evidence that genetic factors play a role in both dependence and abuse. Other theories involve the use of substances as a means to cover up or get relief from other problems (e.g., psychosis, relationship issues, stress), which makes the dependence or abuse more of a symptom than a disorder in itself.

A pattern of substance use leading to significant impairment in functioning. One of the following must be present within a 12 month period: (1) recurrent use resulting in a failure to fulfill major obligations at work, school, or home; (2) recurrent use in situations which are physically hazardous (e.g., driving while intoxicated); (3) legal problems resulting from recurrent use; or (4) continued use despite significant social or interpersonal problems caused by the substance use. The symptoms do not meet the criteria for substance dependence as abuse is a part of this disorder. Prognosis is variable. Both substance abuse and dependence is difficult to treat and often involves a cycle of abstinence from the substance and substance use.

Sleep Disorders: Dyssomnias

Primary Sleep disorders are divided into two subcategories: Dyssomnias are those disorders relating to the amount, quality, and timing of sleep. Parasomnias relate to abnormal behavior or physiological events that occur during the process of sleep or sleep-wake transitions. We use the perm primary to differentiate these sleep disorders from other sleep disorders that are caused by outside factors, such as another mental disorder, medical disorder, or substance use.

Somatization Disorder

Category: Somatoform Disorders

The exact cause of this disorder is unknown. Research has shown some evidence for genetic as well as environmental factors may play a role. These disorders include a history of physical complaints prior to age 30 which occur over a period of several years. There must be a significant impairment in functioning or a history of resulting medical treatment. After appropriate assessment by a physician, there is a lack of explanation for the reported symptoms or for at least the severity of the complaints. Treatment typically includes long term therapy. The involvement of a single physician is important as a history of seeking medical attention and doctor shopping is common. Somatizationis typically a chronic condition with a variable course. Individuals with this disorder do not experience any significant difference in mortality rate or significant illness.

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