In addition to understanding the signs, symptoms and causes of PTSD it is also necessary to gain an understanding of the various subtypes and sub-classifications of PTSD and the probable course of the disorder. PTSD is a generic term, which means that it covers a lot of ground. 

In order to simplify matters for helper it is useful to chunk this so those clearly discernible patterns can be recognised for what they are. In our discussions of the various categories below remember to bear in mind that generally speaking at least, avoidance symptoms of one form or another can be expected to be present from the moment of the critical incident.

There are considered to be five main 'subtypes' of PTSD sufferer to consider. These are listed in DSM-III-R as:

1. Acute

2. Chronic

3. Delayed

4. Delayed and chronic

5. Conditioned Emotional Response

To this list we also have to add however further sub-classifications which are:

• Simple

• Complicated.

Each of these groups is briefly explained:

Acute

In the acute sufferer symptoms appear within and do not last for longer than six months of the originating stressor. The most common manifestation of PTSD, the acute form is also the category that holds the promise of the most optimistic results for helpers and therapists. Where symptoms develop early we are presented with the best opportunities for early diagnosis, intervention and treatment where appropriate.

The other forms of PTSD are a lot less common and present much more of a challenge. This is not to detract in any way the very real distress that can be experienced by the acute sufferer, it is merely stating a fact.

Chronic

The chronic sufferer is displaying symptoms beyond six months of the original stressor. At this point you may be asking why the six month cut off point in both cases. Initially this decision was arbitrary. To complicate things a little bit further an initial diagnosis of acute PTSD within the six-month limit must be re-diagnosed when symptoms persist beyond that time scale.

Delayed

One of the characteristics of PTSD is that the onset of the condition can be delayed for an unpredictable period of time. It can be a period of months, years or decades. Again the arbitrary six-month cut off is used. Where symptoms don't appear until after six-month of the original stressor then delayed PTSD is diagnosed.

Delayed and chronic

This is a logical next step in the diagnostic process. In cases where symptoms do not appear until after six-months but last for greater than six-months then delayed and chronic PTSD is diagnosed.

Conditioned Emotional Response

This is a subclass of the delayed & chronic classification of PTSD mentioned above. This classification is not discussed in any detail here because in order to diagnose its presence full medical facilities are required as it involves the administration of sodium pentathol.

Simple

This refers to the individual sufferer. A 'simple' case of PTSD involves an individual with no previous history of mental health problems (this refers to the full spectrum from stress through neurosis to psychosis) who has experienced difficulties as a result of a single critical incident. In other words until they unexpectedly became involved in a traumatic incident they had never been exposed to any significant psychological distress.

Complicated

'Complicated' cases of PTSD involve sufferers with a previous history of psychological distress, exposure to multiple critical incidents, or previous 

long-term exposure to stress syndrome.

As a rule don't be too concerned with taking all of these different classifications, types and diagnostic criteria on board and working to a rigid framework providing because you have successfully pigeon holed what label belongs with what client. At the end of the day, although an awareness of the different manifestations of PTSD is important (you will come across more with time) it all boils down to being able to work with the individual that you find facing you.

He is less interested in academic knowledge than you are. All he wants to know is can you help him? The text book is useful in its place but can't replace empathy, understanding and a willingness to give it your best.