276 Trauma- and Stressor-Related Disorders
caused by cars or trucks) and those not relate d to the traumatic event (e.g., being fearful of
suffering a heart attack) (Criterion E3). Individuals with PTSD may be very reactive to un-
expected stimuli, displaying a heightened startle response, or jumpiness, to loud noises or
unexpected movements (e.g., jumping markedly in response to a telephone ringing) (Cri-
terion E4). Concentration difficulties, includ ing difficulty remembering daily events (e.g.,
forgetting one’s telephone numb er) or attending to focused t asks (e.g., following a conver-
sation for a sustained period of time), are commonly reported (Criterion E5). Problems
with sleep onset and maintenance are commo n and may be associated with nightmares
and safety concerns or with generalized elevated  arousal that interferes with adequate sleep
(Criterion E6). Some in dividuals also experien ce persistent dissociative symptoms of de-
tachment from their bodies (depersonalization) or the world around them (derealization);
this is reflected in the “with di ssociative symptoms” specifier.
Associated Features Supporting Diagnosis
Developmental regression, such as loss of la nguage in young children, may occur. Audi-
tory pseudo-hallucinations, such as having  the sensory experience of hearing one’s
thoughts spoken in one or more different voic es, as well as paranoid ideation, can be pres-
ent. Following prolonged, repeated, and seve re traumatic events (e.g., childhood abuse,
torture), the individual may additionally experi ence difficulties in regulating emotions or
maintaining stable interpersonal relationship s, or dissociative symptoms. When the trau-
matic event produces violent death, symptoms of both problematic bereavement and PTSD
may be present.