Posttraumatic Stress Disorder 277
Frequently, an individual’s reaction to a tr auma initially meets cr iteria for acute stress
disorder in the immediate aftermath of the trauma. The symptoms of PTSD and the rela-
tive predominance of different symptoms may vary over time. Duration of the symptoms
also varies, with complete recovery within 3 months occurring in approximately one-half
of adults, while some individuals remain symptomatic for longer  than 12 months and
sometimes for more than 50 years. Symptom recurrence and intens ification may occur in
response to reminders of the original trauma, ongoing life stressors, or newly experienced
traumatic events. For older individuals, dec lining health, worsening cognitive function-
ing, and social isolation ma y exacerbate PTSD symptoms.
The clinical expression of reexperiencing can vary across development. Young children
may report new onset of frightening dreams wi thout content specific to the traumatic event.
Before age 6 years (see criteria for preschool su btype), young children are more likely to ex-
press reexperiencing symptoms through play th at refers directly or symbolically to the
trauma. They may not manifest fe arful reactions at the time of the exposure or during reex-
periencing. Parents may report a wide range of  emotional or behavioral changes in young
children. Children may focus on imagined interventions in their play or storytelling. In ad-
dition to avoidance, children  may become preoccupied with reminders. Because of young
children’s limitations in expressing thoughts or labeling emotions, negative alterations in
mood or cognition tend to involve primarily mood changes. Children may experience co-
occurring traumas (e.g., physical abuse, witnes sing domestic violence) and in chronic cir-
cumstances may not be able to identify onset of symptomatology. Avoidant behavior may