Posttraumatic Stress Disorder (PTSD) is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), provides specific criteria to diagnose PTSD in adults, adolescents, and children older than 6 years. These criteria are essential for accurate diagnosis and effective treatment planning. Understanding the DSM-5 PTSD diagnosis criteria is crucial for healthcare professionals, individuals who may be experiencing PTSD symptoms, and their loved ones.
The DSM-5 outlines eight criteria (Criterion A-H) that must be met for a PTSD diagnosis. These criteria encompass different symptom clusters, including exposure to trauma, intrusion symptoms, avoidance behaviors, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity. The symptoms must also cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and not be attributable to the physiological effects of a substance or another medical condition. Let’s explore each criterion in detail to provide a comprehensive understanding of the DSM-5 PTSD diagnosis.
Criterion A: Exposure to Traumatic Event
The first criterion for a DSM-5 PTSD diagnosis involves exposure to actual or threatened death, serious injury, or sexual violence. This exposure can occur in one or more of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing in person the traumatic event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). It’s important to note that Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.
Criterion B: Intrusion Symptoms
Criterion B for DSM-5 PTSD diagnosis requires the presence of one or more intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children older than 6 years, this may manifest as repetitive play where themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Children may experience frightening dreams without recognizable content.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. These reactions can range in severity, with extreme cases involving a complete loss of awareness of present surroundings. In children, trauma-specific reenactment may occur in play.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Criterion C: Avoidance Behaviors
Criterion C involves the persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Criterion D: Negative Alterations in Cognitions and Mood
Criterion D for DSM-5 PTSD diagnosis pertains to negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
- Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Criterion E: Marked Alterations in Arousal and Reactivity
Criterion E focuses on marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
- Reckless or self-destructive behavior.
- Hypervigilance.
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Criterion F, G, and H: Duration, Distress/Impairment, and Exclusion
The final criteria for DSM-5 PTSD diagnosis are:
- Criterion F: Duration. The disturbance (Criteria B, C, D and E) is more than 1 month.
- Criterion G: Distress or Impairment. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Criterion H: Exclusion. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Specifiers: Dissociative Symptoms and Delayed Expression
The DSM-5 also includes specifiers to further characterize PTSD:
- With dissociative symptoms: This specifier is used when an individual’s symptoms meet the criteria for PTSD, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either depersonalization (feeling detached from one’s mental processes or body) or derealization (experiences of unreality of surroundings).
- With delayed expression: This specifier applies if the full diagnostic criteria are not met until at least 6 months after the event, although the onset and expression of some symptoms may be immediate.
Understanding these DSM-5 criteria is essential for recognizing and diagnosing PTSD. If you or someone you know is experiencing symptoms following a traumatic event, seeking professional evaluation from a mental health expert is crucial for appropriate diagnosis and care. Accurate DSM-5 PTSD diagnosis is the first step towards effective treatment and recovery.
