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 |
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| 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 |
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| 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 |
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| 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. |
