Posttraumatic Stress Disorder 273
Note:  Witnessing does not include events that are witnessed only in electronic me-
dia, television, movies, or pictures.
3. Learning that the traumatic event(s) o ccurred to a parent or caregiving figure.
B. Presence of one (or more) of the following intrusion symptoms associated with the
traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
Note:  Spontaneous and intrusive memories may not necessarily appear distress-
ing and may be expressed as play reenactment.
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
Note:  It may not be possible to ascertain that the frightening content is related to
the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the
traumatic event(s) were recurring. (Such reactions may occur on a continuum, with
the most extreme expression being a complete loss of awareness of present sur-
roundings.) Such trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the traumatic event(s).
C. One (or more) of the following symptoms, representing either persistent avoidance of
stimuli associated with the traumatic event(s) or negative alterations in cognitions and
mood associated with the traumatic event(s), must be present, beginning after the
event(s) or worsening after the event(s):
Persistent Avoidance of Stimuli
1. Avoidance of or efforts to avoid activities, places, or physical reminders that arouse