Recurrent, involuntary and intrusive memories of the trauma

Traumatic nightmares

Dissociation/flashbacks, which may range from brief responses to outright loss of consciousness

Prolonged or intense distress after exposure to reminder of the trauma

Physiological reactivity in response to trauma-related stimuli

Inability to recall event related to trauma (unrelated to head injury or substance use)

Distorted beliefs about the world (eg, ‘I am a terrible person,’; ‘The world is unsafe’)

Persistent distorted blame of self or others for causing the traumatic event

Negative trauma-related emotions (eg, fear, horror, guilt, anger)

Markedly decreased interest in pretrauma activities

Feeling alienated from others (detached or estranged)

Constricted affect/persistent inability to experience positive emotions

Numbing, detachment or decreased emotional responsiveness

Decrease in awareness

Derealisation (feeling that one’s surroundings are unreal)

Depersonalisation (feeling disconnected from one’s body or thoughts; may be described as a feeling of observing the self as an outsider or being in a dream)

Irritable or aggressive behaviour

Self-destructive or reckless behaviour

Hypervigilance

Exaggerated startle response

Problems with concentration

Sleep disturbance

Avoidance of trauma-related memories, thoughts or feelings

Avoidance of external reminders of the trauma