Posttraumatic Stress Disorder 279
ing is exhibited across social, interpersonal, develo pmental, educational, physical health,
and occupational domains. In community and veteran samples, PTSD is associated with
poor social and family relationships, absent eeism from work, lower income, and lower ed-
ucational and occupational success.
Differential Diagnosis
Adjustment disorders. In adjustment disorders, the st ressor can be of any severity or
type rather than that required by PTSD Crit erion A. The diagnosis of an adjustment dis-
order is used when the response to a stressor that meets PTSD Criterion A does not meet
all other PTSD criteria (or criteria for another mental disorder). An adjustment disorder is
also diagnosed when the symptom pattern of PTSD occurs in response to a stressor that
does not meet PTSD Criterion A (e .g., spouse leaving, being fired).
Other posttraumatic diso rders and conditions. Not all psychopathology that occurs in
individuals exposed to an extreme stressor sh ould necessarily be attributed to PTSD. The
diagnosis requires that trauma exposure prec ede the onset or exacer bation of pertinent
symptoms. Moreover, if the symptom response pattern to the extreme stressor meets cri-
teria for another mental disorder, these diagnoses should be given instead of, or in addi-
tion to, PTSD. Other diagnoses and conditions are excluded if they are better explained by
PTSD (e.g., symptoms of panic disorder that  occur only after exposure to traumatic re-
minders). If severe, symptom response patter ns to the extreme stressor may warrant a sep-
arate diagnosis (e.g., dissociative amnesia). 
Acute stress disorder. Acute stress disorder is distin guished from PTSD because the
symptom pattern in acute stress disorder is restricted to a duration of 3 days to 1 month