Не все ПТСР одинаковы. Что нужно знать о подтипах посттравматического стрессового расстройства?

PTSD causes anxiety, disrupts normal memory processing, and sucks a portion of people who've experienced or witnessed a trauma into a whirlwind of nasty symptoms that make daily functioning hard and essentially force them to orbit their trauma for prolonged periods of time.

If you're reading this, I'm pretty sure you know that much. You'll probably also be aware that, to be diagnosed with post-traumatic stress disorder, you have to meet the diagnostic criteria as laid out in the fifth edition of the diagnostic and statistical manual of mental disorders, (DSM-5) in the United States at least. 

If you suffer from PTSD, or someone you care about does, understanding these subtypes better may be the key to understanding yourself or the person you care about in more depth, as well. Let's take a look. 

Subtypes of PTSD recognized in the DSM-5

The DSM-5 has recognized several subtypes of post-traumatic stress disorder, which the document deals with as "specifiers". 

The first is post-traumatic stress disorder "with dissociative symptoms". Dissociation describes a spectrum of ways in which people detach themselves from reality, with Dissociative Identity Disorder (formerly called Multiple Personality Disorder) representing the most extreme end. In people with PTSD, this may — the DSM-5 says — manifest in one of two ways:

• Depersonalization, which focuses on the internal experience. A person may feel like they're detached from their body, feelings, or thoughts, and experience them as if they were happening to someone else, or are simply observing. This can cause a "dreamlike" and unreal feeling. 
• Derealization, which rather focuses on someone's environment. Someone may experience the world and the people in it as in some way unreal, unreachable, or distorted. 

Research estimates that somewhere between 15 and 30 percent of combat veterans with PTSD will experience some degree of dissociation, and that this increases their risk of suicide — as well as their day-to-day functional impairments and their risk of other mental disorders. 

The second specifier the DSM-5 recognizes is "with delayed onset". In this subtype of PTSD, the full symptoms won't emerge until at least six months after the trauma is over, though people who fall into this category can experience some signs of PTSD even prior to that.

We'll also note that the diagnostic criteria for children six and under are slightly different, requiring fewer symptoms to be present. PTSD in children six and under can, therefore, also be seen as a subtype. 

Subtypes of PTSD discussed in scientific studies

Several other subtypes of PTSD not currently recognized by the DSM have also been discussed in the scientific literature. 

The first of these is so-called complex post-traumatic stress disorder, which has been studied quite extensively and is featured in the World Health Organization's International Classification of Diseases (ICD-11). This subtype of PTSD can affect people who were exposed to severe, prolonged, or repeated trauma. Besides your typical PTSD symptoms, C-PTSD also leads to:

• Persistent differences in emotion regulation and processing — chronic existential sadness, explosive aggression, or internalized anger that may be revenge-focus, and suicidal ideation. 
• Severely-impacted self-image. Someone living with C-PTSD may feel worthless, experience chronic (and unrealistic) guilt and shame, and completely alienated from society and other humans, to a much deeper level than someone with classic PTSD.
• Severely-impacted relationships with others. C-PTSD may lead to near-complete distrust in people at large, but it can also cause people to feel unworthy of healthy human relationships, to self-isolate to extreme degrees, or to repeatedly look for "savior" figures. 
• C-PTSD can lead to severe dissociation, memory gaps, and severe intrusion symptoms as well as a profound loss of faith and persistent hopelessness. 

Studies have also differentaited between internalizing and externalizing subtypes of PTSD.

Internalizing would mean directing symptoms at the self, in one way or another. People with this profile have higher rates of co-existing depression, are more likely to be introverted, and feel less able to reach out for help. They may suffer from more social isolation, and are less able to experience any positive emotions.

Externalizing represents the opposite, and people with this subtype of PTSD have higher rates of aggression, and less able to control how they react. This is an "explosive" subtype. Substance abuse is also more commonly seen in this kind of PTSD.

What else do you need to know?

Not all trauma-related disorders are PTSD. Other mental disorders that can result from trauma or severe stress include:

• Reactive attachment disorder, diagnosed in some children who have experienced neglect or abuse and who cannot form healthy attachments and relationships with parents and caregivers as a result. 
• Disinhibited social engagement disorder, another childhood disorder that may affect children who were abandoned, and especially those who were institutionalized. It causes children to behave with inappropriate and potentially dangerous closeness to all adults, treating them as if they would treat a loving parent. 
• Acute stress disorder, with similar symptoms as PTSD and also following a trauma, but this covers symptoms that emerge within one month of the trauma. 

The bottom line

Human reactions to trauma vary — as does the nature of trauma, and the kinds of lives people had before they lived through a horrific event. It's no wonder that PTSD doesn't look the same in every trauma survivor. Perhaps, as science advances, even more subtypes will be uncovered and recognized.