Symptoms and Diagnosis of PTSD

Post-traumatic stress disorder (PTSD) occurs after a traumatic event and interferes with a person's ability to function. You may wonder if you or someone you care about has PTSD, and whether you need to get professional help. If you are experiencing symptoms of PTSD, it is important to see a doctor so that you can get the right diagnosis and treatment.

DSM-5 Criteria for PTSD

There are specific requirements that must be met for a diagnosis of PTSD. These requirements are outlined in the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR).

Criterion A: Stressor

Exposure or threat of death, serious injury, or sexual violence in one or more of the following ways:

1. You directly experienced the event.
2. You witnessed the event happen to someone else, in person.
3. You learned of a close relative or close friend who experienced an actual or threatened accidental or violent death.
4. You had repeated indirect exposure to distressing details of the event(s). This could occur in the course of professional duties (first responders, collecting body parts, or professionals repeatedly exposed to details of child abuse). This does not include non-work related exposure through electronic media, television, movies, or pictures.

Criterion B: Intrusion Symptoms

The traumatic event is persistently re-experienced in one or more of the following ways:

• Recurrent, involuntary, and intrusive memories. Children older than six may express this symptom through repetitive play in which aspects of the trauma are expressed.
• Traumatic nightmares or upsetting dreams with content related to the event. Children may have frightening dreams without content related to the trauma.
• Dissociative reactions, such as flashbacks, in which it feels like the experience is happening again. These may occur on a continuum ranging from brief episodes to complete loss of awareness. Children may re-enact the events in play.
• Intense or prolonged distress after exposure to traumatic reminders.
• Marked physiological reactivity, such as increased heart rate, after exposure to traumatic reminders.

Criterion C: Avoidance

Persistent effortful avoidance of distressing trauma-related reminders after the event as evidenced by one or both of the following:

• Avoidance of trauma-related thoughts or feelings.
• Avoidance of trauma-related external reminders, such as people, places, conversations, activities, objects, or situations.

Criterion D: Negative Alterations in Mood

Negative alterations in cognition and mood that began or worsened after the traumatic event as evidenced by two or more of the following:

• Inability to recall key features of the traumatic event. This is usually dissociative amnesia, not due to head injury, alcohol, or drugs.
• Persistent, and often distorted negative beliefs and expectations about oneself or the world, such as "I am bad," or "The world is completely dangerous."
• Persistent distorted blame of self or others for causing the traumatic event or for the resulting consequences.
• Persistent negative emotions, including fear, horror, anger, guilt, or shame.
• Markedly diminished interest in activities that used to be enjoyable.
• Feeling alienated, detached or estranged from others.
• Persistent inability to experience positive emotions, such as happiness, love, and joy.

Criterion E: Alterations in Arousal and Reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event, including two or more of the following:

1. Irritable or aggressive behavior
2. Self-destructive or reckless behavior
3. Feeling constantly "on guard" or like danger is lurking around every corner (hypervigilance)
4. Exaggerated startle response
5. Problems in concentration
6. Sleep disturbance

Criterion F: Duration

Persistence of symptoms in Criteria B, C, D, and E for more than one month.

Criterion G: Functional Significance

Significant symptom-related distress or impairment of different areas of life, such as social or occupational.

Criterion H: Exclusion

The disturbance is not due to medication, substance use, or other illness.

Changes in Diagnostic Criteria

There are a few changes in the latest version of the DSM regarding PTSD diagnosis.

Key changes include:

• More clearly defining what kind of events are considered traumatic in Criterion A
• Adding a fourth type of exposure in Criterion A
• Increasing the number of symptom groups from three to four by separating avoidance symptoms into their own group (Criterion C)
• Increasing the number of symptoms from 17 to 20
• Changing the wording of some of the symptoms from DSM-IV
• Adding a new set of criteria for children aged 6 or younger
• Eliminating the "acute" and "chronic" specifiers
• Introducing a new specifier "with dissociative symptoms"

You can review the rationale behind these changes, as well as look at other changes in the DSM-5, at the website for the American Psychiatric Association (APA).

The most recent text revision to the DSM-5 also includes a criterion change for post-traumatic stress disorder in children. This change involved removing the note in criteria A.2 stating that witnessing a traumatic event does not include events only viewed on television, movies, pictures, or electronic media. According to the American Psychiatric Association, this note was redundant since the diagnostic criteria already state that the event must be witnessed in person.

Other Diagnostic Tools

In addition to using the DSM-5 manual to assess for PTSD criteria, a medical professional will likely want to complete a physical examination to check for medical problems that could be contributing to or causing symptoms.

A psychological evaluation is likely to be recommended, which allows for you to openly discuss with your provider some of the events that have led to you experiencing these symptoms. During this evaluation, you would share with a provider signs and symptoms you're experiencing, as well as the duration and level of intensity of these.

The Difference Between PTSD and Stress

Not everyone who has experienced a traumatic event will develop PTSD. After a traumatic event, it is normal to have strong feelings of anxiety, sadness, or stress. Some people may even experience nightmares, memories about the event, or problems sleeping at night, which are common characteristics of PTSD.

However, these symptoms do not necessarily mean that you have PTSD. Think of it this way: Headaches can be a symptom of a bigger problem, such as meningitis.

However, having a headache does not necessarily mean that you have meningitis. The same is true for PTSD. Many of the symptoms are part of the body's normal response to stress, but having them does not mean that you have PTSD.

When to See a Professional

The debilitating symptoms of PTSD can make living, working, and interacting difficult. In fact, many people struggling with post traumatic stress disorder can turn to unhealthy coping skills like substance abuse or self-harm in an attempt to minimize or escape from their emotional distress.

If you have been experiencing symptoms for longer than a month, it could be helpful for you to talk with a professional. When you are dealing with nightmares, flashbacks, and a negative outlook about yourself and others, it can begin to feel like things will never change.

Finding a qualified professional to help can make all the difference, bringing back hope through the sharing of your experiences and helping you learn healthy, effective ways of coping.

PTSD Discussion Guide

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Time Doesn't Always Help

Sometimes after a traumatic experience, people believe that their symptoms will eventually go away over time. This eventual lessening of distressing symptoms can happen for some people—but not for everyone.

Even if months or years have passed, it can be helpful for you to speak with a qualified professional to gain an accurate understanding of what is happening for you and be connected with appropriate resources that can help you regain your quality of life.

Related Conditions

Although the hallmark of post-traumatic stress disorder is having experienced or witnessed a traumatic event, there are a variety of distressing symptoms that someone with PTSD will experience after the event.

Understanding that some of these symptoms may overlap with other mental health conditions, it is important that a thorough evaluation is done to make sure the diagnosis of PTSD is accurate.

Other conditions that could be discussed or explored with your health care provider, due to the symptoms you might be experiencing, could include things like:

• Obsessive-compulsive disorder
• Acute stress disorder
• Adjustment disorder
• Panic disorder
• Generalized anxiety disorder
• Major depression
• Substance abuse
• Eating disorders

Again, because some of the distressing symptoms can overlap a bit with other mental health conditions, it is important to talk with a qualified professional to make sure you receive an accurate diagnosis and are provided with appropriate resources for care and treatment.

Takeaways

Not everyone who experiences a traumatic event will develop PTSD. However, it is important to be aware of the signs and symptoms. Seeking treatment and being open and honest with your healthcare provider about your symptoms can ensure you get the treatment you need to process and cope with your experience.