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ICD-10 - Reactions to Severe Stress


[From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...

Acute stress reaction
  1. The patient must have been exposed to an exceptional mental or physical stressor.
  2. Exposure to the stressor is followed by an immediate onset of symptoms (within 1 hour).
  3. Two groups of symptoms are given: the acute stress reaction is graded as:
    Only Criterion (1) below is fulfilled.
    Criterion (1) is met, and there are any two symptoms from Criterion (2).
    Either criterion (1) is met, and there are any four symptoms from criterion (2); or there is dissociative stupor.
    1. Criteria B, C, and D for generalized anxiety disorder are met.
      1. Withdrawal from expected social interaction.
      2. Narrowing of attention
      3. Apparent disorientation
      4. Anger or verbal aggression
      5. Despair or hopelessness
      6. Inappropriate or purposeless overactivity
      7. Uncontrollable and excessive grief (judged by local cultural standards).
  4. If the stressor is transient or can be relieved, the symptoms must begin to diminish after not more than 8 hours. If exposure to the stressor continues, the symptoms must begin to diminish after not more than 48 hours.
  5. Most commonly used exclusion clause. The reaction must occur in the absence of any other concurrent mental or behavioral disorder in ICD-10 (except generalized anxiety disorder and personality disorders) and not within 3 months of the end of an episode of any other mental or behavioral disorder.
Posttraumatic stress disorder
  1. The patient must have been exposed to a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which would be likely to cause pervasive distress in almost anyone.
  2. There must be persistent remembering or “reliving” of the stressor in intrusive “flashbacks,” vivid memories, or recurring dreams or in experiencing distress when exposed to circumstances resembling or associated with the stressor.
  3. The patient must exhibit an actual or preferred avoidance of circumstances resembling or associated with the stressor, which was not present before exposure to the stressor.
  4. Either of the following must be present:
    1. inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor;
    2. persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor), shown by any two of the following:
      1. difficulty in falling or staying asleep;
      2. irritability or outbursts of anger;
      3. difficulty in concentrating;
      4. hypervigilance;
      5. exaggerated startle response.
  5. Criteria B, C, and D must all be met within 6 months of the stressful event or of the end of a period of stress. (For some purposes, onset delayed more than 6 months may be included, but this should be clearly specified.)

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