This avoidance often expresses itself as “emotional anesthesia,” ie, “markedly diminished interest or participation in significant activities,” “feeling of detachment,” a “restricted range of affect,” and a “sense of a foreshortened future.” Sometimes amnestic or dissociative symptoms (which may also be interpreted as avoidance) appear in response to the extreme reexperiencing, and are Inhibitors,research,lifescience,medical thought of as another maladaptive mechanism that originally evolves to buffer the individual from painful recollections. The fourth feature of PTSD (Criterion D) is increased arousal. Patients are constantly “on alert,” have difficulty in falling or staying asleep,

suffer from irritability or outbursts of anger, have difficulty concentrating, and the following site experience hypervigilancc and exaggerated startle response. For many of the patients and their Inhibitors,research,lifescience,medical families, this group of symptoms is particularly difficult as the families need to maintain a very calm environment while the patients are concerned about losing control. An additional criterion relates to the functional impairment of the symptoms, described as causing severe impairment in social, occupational, and family areas of life. Comorbidity with other mental

disorders is Inhibitors,research,lifescience,medical prevalent in PTSD. A recent epidemiologic survey indicated that approximately 80 % of PTSD patients meet criteria for at least one other psychiatric diagnosis.3,10 The most common disorders experienced concurrently with PTSD found in the US National Comorbidity study are major depression (48.5 in women and 47.9 in men), other anxiety disorders (more than one third), and substance abuse (found in one third of women Inhibitors,research,lifescience,medical and half of all men).6 Depression seems to be a common disorder found in comorbidity with PTSD as evidenced by additional studies of different populations.11,12 Since symptoms such as guilt, ruminations, decreased concentration, anxiety, and outbursts of anger are parts of other, more familiar disorders, the diagnosis of PTSD may be overlooked. Many times such patients may be misdiagnosed

Inhibitors,research,lifescience,medical with depression, sleep disturbance, personality disorder, substance abuse, malingering, or even schizophrenia.4,5 Two studies of psychotic female inpatients demonstrate this point. These studies indicate that patients with a history of childhood sexual abuse were more likely to have intrusive, avoidant/numbing, and hyperarousal symptoms than their nonabused counterparts; a full 66 % of these women met the diagnosis for PTSD, but had never been diagnosed.13,14 Entinostat It has further been suggested that the high levels of comorbidity may point to the possibility of several different subgroups of PTSD.15-17 An example of such a grouping is development of psychological or behavioral problems before, concurrent with, or after exposure to the traumatic stressor.16 An alternative approach suggests that the picture may be more complex, that associated psychiatric disorders are not purely comorbid, but “interwoven with the PTSD.