activity (Criterion B5) often occurs when the individual is exposed to triggering events that
resemble or symbolize an aspect of the trauma tic event (e.g., windy days after a hurricane;
seeing someone who resembles one’s perpetrator). The trigge ring cue could be a physical
sensation (e.g., dizziness for survivors of head trauma; rapid heartbeat for a previously
traumatized child), particularly for indivi duals with highly somatic presentations.
Stimuli associated with the trauma are pers istently (e.g., always or almost always)
avoided. The individual commonly makes delib erate efforts to avoid thoughts, memories,
feelings, or talking about the traumatic event (e .g., utilizing distraction techniques to avoid
internal reminders) (Criterion C1) and to av oid activities, objects, situations, or people
who arouse recollections of it (Criterion C2).
Negative alterations in cognitions or mood associated with the event begin or worsen
after exposure to the event. These negative al terations can take various forms, including an
inability to remember an important aspect of the traumatic event; such amnesia is typically
due to dissociative amnesia and is not due to he ad injury, alcohol, or drugs (Criterion D1).
Another form is persistent (i.e., always or almost always) and exaggerated negative ex-
pectations regarding important aspects of life a pplied to oneself, others, or the future (e.g.,
“I have always had bad judgment”; “People in  authority can’t be trusted”) that may man-
ifest as a negative change in perceived identi ty since the trauma (e.g., “I can’t trust anyone
ever again”; Criterion D2). Individuals with PTSD may have persistent erroneous cogni-
tions about the causes of the traumatic event that lead them to blame themselves or others