Presence of one or more of the following intrusion symptoms associated with the traumatic event(s) beginning after the traumatic event(s) occurred:

• Recurrent, involuntary and intrusive distressing memories of the traumatic event(s).
• Recurrent distressing dreams in which the content and/or emotion of the dream are related to the traumatic event(s).
• Dissociative reactions (e.g. flashbacks in which the individual feels or acts as if the traumatic event(s) were recurring.
• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
• Marked physiological reactions (dizziness, rapid heartbeat, sweating) to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
• Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
  • Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events(s).
  • Avoidance of or efforts to avoid external reminders such as people, places, conversations, activities, objects or situations that arouse distressing memories, thoughts or feelings about the traumatic event(s).
• Negative effects regarding thinking and mood associated with the traumatic event(s), as evidenced by two or more of the following:
  •  Inability to remember an important aspect of the traumatic event(s).
  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g. “I am bad,” “ No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently damaged”)
  • Persistent, distorted thoughts about the cause or consequences of the traumatic event(s) that lead the individual to blame themselves or others.
  • Persistent negative emotional state (e.g. fear, horror, anger, guilt, or shame).
  • Markedly diminished interest or participation in significant activities.
  •  Feelings of detachment or estrangement from others.
  • Persistent inability to experience positive emotions like happiness, satisfaction or loving feelings.
• Marked alterations in arousal and reactivity associated with the traumatic event(s), as evidenced by two or more of the following:
  • Irritable behavior and angry outbursts with little or no provocation, typically expressed as verbal or physical aggression toward people or objects.
  • Reckless or self-destructive behavior.
  • Hyper-vigilance.
  • Exaggerated startle response.
  • Problems with concentration.
• Sleep disturbance including difficulty falling or staying asleep or restless sleep.
  • Duration of the disturbance is more than 1 month. If less than one month the diagnosis of Acute Stress Disorder may apply.
  • The disturbance causes clinically significant distress or impairment in social, occupation or other important areas of functioning.