Criterion C1 captures avoidance of, or efforts to avoid, distressing memories, thoughts, or feelings about the traumatic event(s). The focus is on the effort to avoid, rather than the success of the person’s avoidance strategies. In general, any active effort would be coded as clearly present, including healthy coping such as deep breathing, if it is engaged in persistently to avoid thoughts or feelings about the trauma. Avoidance that is pressured, desperate, and/or rigid (e.g., staying busy all the time to the extent that the respondent eats dinner over the sink to avoid sitting down and having his/her thoughts turn to the trauma) would potentially rise to the level of pronounced.

We typically do not give an intensity rating of extreme intensity unless the respondent engages in substance/ETOH abuse or some other dramatic effort such as self-harming behaviors to avoid thoughts/feelings. Of note, not all substance/ETOH abuse is coded as extreme intensity. Instead, look for examples that the person is trying every possible option to avoid these thoughts and feelings before giving an extreme intensity rating.

It is very important that you only code avoidance of internal reminders for this item; these are usually memories of the event itself or peritraumatic emotions. If the person starts to talk about external reminders, you can gently redirect by saying something like “I’m actually going to ask you about things you avoid for a later question, but for this question, I’m interested in whether you avoid thoughts or feelings about the event”. Whereas C2 will usually involve thoughts/feelings of the trauma which are triggered by the external reminders, C1 will never involve external reminders.

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Criterion C2 captures avoidance of or efforts to avoid external reminders, such as people, places, conversations, activities, objects, or situations that arouse distressing memories, thoughts, or feelings about the traumatic event(s).

You will need to ask about and clarify avoidance for people, places, and situations, and ask about whether the person has had opportunities to engage in the behaviors. If the respondent has not been to the place she was raped because it is in another state and she has had no reason/opportunity to go there in the past month, this would not be counted towards current (past month) PTSD.

When assessing intensity, you can ask about how things would be different if they weren’t avoiding reminders, to get an idea of how significant and/or how interfering it is. This is particularly important in cases where the avoidance has become a part of their life and takes little to no effort to enact. C2 includes ALL avoidance that is not explained by another disorder (e.g., panic disorder) and that can be linked to trauma through either content or timing. Return to list