These symptoms, known as posttraumatic stress symptoms (PTSS), provide a more continuous measure of the pathological traumatic stress response and are often used as clinical indicators for intervention and treatment. PTSS often cluster together but do not require the prolonged duration or functional impairment criteria needed for a full diagnosis of PTSD, making PTSS a more commonly observed trauma response.16

Though PTSS lack clinical diagnostic criteria, their clinical utility should not be underestimated. Individuals experiencing PTSS who do not meet the threshold for PTSD may qualify for a diagnosis of acute stress disorder or adjustment disorder, and may be considered candidates for further clinical evaluation, monitoring, or treatment. In research contexts, the PTSS construct is used far more broadly, usually encompassing any posttraumatic symptom that does not result in a diagnosis of PTSD.


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The broad interpretation of PTSS in research is demonstrated in the cancer survivorship literature, with reported rates of PTSS ranging from 15%–88%.17 Despite this variability, the widespread investigation of PTSS in cancer survivorship research has yielded valuable epidemiologic, qualitative, and clinical information that further elucidates the adjustment experience of young cancer survivors. 

Table 1 – DSM-IV : posttraumatic stress disorder criteria
DSM-IV criteria Operationalization Considerations for AYA cancer survivors
Criteria A
Exposure to traumatic event threatening death or serious injury of self or others
Response characterized by intense fear, helplessness, or horror Cancer not a discrete event
Risk of focusing illusion
Criteria B
Re-experiencing (one or more symptom[s] required)
Intrusive recollections
Distressing dreams
Recurring or reliving the event
Internal/external cue(s) triggering psychological distress or physiological reactivity
Well-founded fears about relapse/future health
Criteria C
Avoidance (three or more symptom[s] required)
Effortful avoidance of thoughts, feelings, or anything associated with the trauma
Inability to recall aspects of the trauma
Social withdrawal, diminished interest in activities
Emotional numbing
Sense of a foreshortened future
Long-term care/late effects make avoidance difficult
Cognitive impairment
Psychosocial sequelae
Possibility of recurrence
Criteria D
Arousal (two or more symptom[s] required)
Difficulty falling or staying asleep
Irritability or outbursts of anger
Concentration difficulty
Hypervigilance
Exaggerated startle response
Neurocognitive late effects
Sleep-related late effects
Criteria E
Duration of disturbance
Symptoms persist more than 1 month Late effects typically persist beyond 30 days
Criteria F
Clinically significant distress or functional impairment
Cancer therapy late effects may impact functioning
Abbreviations: DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition; AYA, adolescent and young adult.