International Classification of Diseases (ICD-10) – Reactions to Stress

I include this post as an appendix to other posts I have made which relate to the psychological effects of witnessing (and maybe photographing) stressful events.

The International Classification of Diseases is developed by the World Health Organisation and describes and defines characteristic features of diseases. These are defined for research and epidemiological studies to have consistency across the world in diagnoses. Chapter V of this relates to mental disorders and describes several types of reaction to stress. Of note in the context of my studies here are:

Extracts from
International Classification of Diseases 10 (ICD-10), WHO, Geneva

F43.0 Acute stress reaction
“A transient disorder of significant severity which develops in an individual without any other apparent mental disorder in response to exceptional physical and/or mental stress and which usually subsides within hours or days. The stressor may be an overwhelming traumatic experience involving serious threat to the security or physical integrity of the individual or of a loved person(s) (e.g. natural catastrophe, accident, battle, criminal assault, rape), or an unusually sudden and threatening change in the social position and/or network of the individual, such as multiple bereavement or domestic fire. The risk of this disorder developing is increased if physical exhaustion or organic factors (e.g. in the elderly) are also present.
Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions, as evidenced by the fact that not all people exposed to exceptional stress develop the disorder. The symptoms show great variation but typically they include an initial state of “daze”, with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor – see F44.2), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within 2-3 days (often within hours). Partial or complete amnesia (see F44.0) for the episode may be present.”

F44.2 Dissociative stupor
“The individual’s behaviour fulfils the criteria for stupor, but examination and investigation reveal no evidence of a physical cause. In addition, as in other dissociative disorders, there is positive evidence of psychogenic causation in the form of either recent stressful events or prominent interpersonal or social problems. Stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch. The individual lies or sits largely motionless for long periods of time. Speech and spontaneous and Purposeful movement are completely or almost completely absent. Although some degree of disturbance of consciousness may be present, muscle tone, posture, breathing, and sometimes eye-opening and coordinated eye movements are such that it is clear that the individual is neither asleep nor unconscious.”
F43.1 Post-traumatic stress disorder
“This arises as a delayed and/or protracted response to a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (e.g. natural or man-made disaster, combat, serious accident, witnessing the violent death of others, or being the victim of torture, terrorism, rape, or other crime). Predisposing factors such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence.
Typical symptoms include episodes of repeated reliving of the trauma in intrusive memories (“flashbacks”) or dreams, occurring against the persisting background of a sense of “numbness” and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. Commonly there is fear and avoidance of cues that remind the sufferer of the original trauma. Rarely, there may be dramatic, acute bursts of fear, panic or aggression, triggered by stimuli arousing a sudden recollection and/or re-enactment of the trauma or of the original reaction to it.
There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. Excessive use of alcohol or drugs may be a complicating factor. The onset follows the trauma with a latency period which may range from a few weeks to months (but rarely exceeds 6 months). The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of patients the condition may show a chronic course over many years and a transition to an enduring personality change (see F62.0).”

Extracts from: International Classification of Diseases 10 (ICD-10), WHO, Geneva