A person who witnessed the World Trade Center attack experiences sleep disturbances with distressing dreams, withdrawal, foreboding on the anniversary, and depression. This presentation is most consistent with

• A. Major depressive disorder
• B. Post-traumatic stress disorder
• C. Generalized anxiety disorder
• D. Dysthymic disorder

Answer: (D)

Post-traumatic stress disorder is the best fit. After a life-threatening event, re-experiencing symptoms like distressing dreams and sleep disturbances are common, reflecting intrusive memories that intrude despite the individual’s attempts to avoid thinking about the event. Withdrawal or avoidance of reminders is another hallmark, seen here as pulling back from others or situations that recall the trauma. Feeling foreboding on the anniversary signals persistent hyperarousal and intrusive recollections triggered by reminders, which together maintain distress beyond the immediate aftermath of the event. Although depression can occur with PTSD, the presence of trauma-related re-experiencing and avoidance points more specifically to PTSD rather than a mood disorder. Dysthymic disorder involves chronic, milder depressive symptoms without the trauma-linked re-experiencing or avoidance patterns. Generalized anxiety disorder centers on pervasive worry across many domains rather than traumatic reminders and nightmares.