Negative alterations in cognition and mood

What are negative alterations in cognition and mood?

According to the DSM-5, at least two “negative alterations in cognitions and mood” are required for a diagnosis of PTSD. These include negative thoughts or feelings that began or worsened after the trauma, an inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect (e.g., fear, horror, anger, guilt, or shame), decreased interest in activities, feeling isolated, and difficulty experiencing positive affect.

What is the evidence for negative alterations in cognition and mood?

Moderate to low quality evidence finds five clusters of items relating to negative alterations in cognition and mood. These are decreased interest, detachment, restricted affect, foreshortened future, and guilt/shame.

Decreased interest items include; I lost interest in activities which used to mean a lot to me, I lost interest in my usual activities, I lost interest in free time activities that used to be important to me, I lost interest in social activities, and I lost interest in activities that I used to enjoy.

Detachment items include; I felt distant or cut off from people, and no one, not even my family, understood how I felt.

Restricted affect items include; I was not able to feel normal emotions, it seemed as if I have no feelings, I felt emotionally numb, I felt unemotional about everything, and I was unable to have loving feelings for people who are close to me.

Foreshortened future items include; I felt as if my plans for the future would not come true, I felt that I had no future, making long term plans seemed meaningless to me, I felt as if I don’t have a future, and I felt as if my future would somehow be cut short.

Guilt items include; I felt guilty, I felt ashamed of the traumatic events that happened to me, I blamed myself, I felt guilt over things I did around the time of the event, and I felt guilty for having survived.

Moderate to high quality evidence found a strong relationship between increased dysfunctional appraisals of trauma and increased PTSD symptoms in children and adolescents. In adults, support was found for an association between increased shame and increased PTSD symptoms. There were also relationships between increased symptoms and increased guilt, particularly feelings of wrongdoing and self-blame. More emotional numbing was associated with poorer mental health in general, poor social functioning, and more substance use and aggression in veterans. More emotional numbing was also associated with more treatment initiation and better treatment retention in veterans.

Moderate to low quality evidence found decreased reward functioning in people with PTSD, being a reflection of an inability to feel pleasure. There was less anticipation and approach reward functioning, and also decreased hedonic responses. This was seen more in females than in males.

August 2021

Image: ©2014 Igor Stevanovic –

Last updated at: 2:06 am, 29th August 2021
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