APA DSM-5 Diagnostic Criteria for PTSD

PTSD is the development of characteristic symptoms after exposure to one or more traumatic events. All of the diagnostic criteria must be met to be diagnosed with PTSD, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).1,2

These criteria apply to adults 18 years and older.

1 or more

• Directly experiencing the traumatic event(s)
• Witnessing, in person, the 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)*

*Does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

1 or more of the following 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)
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings)
• 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)

Associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by 1 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)

Associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 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)

Associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 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)

Specify if:

With delayed expression: 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).

REFERENCES

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. DSM-5™. American Psychiatric Publishing; 2013. 1.

Lancaster CL, et al. Posttraumatic stress disorder: overview of evidence-based assessment and treatment. J Clin Med. 2016;5:E105.