Diagnostic criteria for PTSD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth revision (DSM-5)
The information about diagnostic criteria is for informational purposes only and is not intended for self-diagnosis or self-treatment. Only a doctor can correctly interpret the symptoms and make a diagnosis.
Here are the diagnostic criteria for PTSD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5).
Criterion А
Experiencing death or threat of death, being seriously injured or experiencing a threat of being seriously injured, being sexually assaulted or threatened to be assaulted, which may occur in any of the following ways:
- Experiencing the traumatic event firsthand.
- Witnessing someone’s traumatic event.
- A report about an event that happened to close family members or close friends. In cases of immediate or possible death of a family member or friend, the event must be sudden or unexpected.
- Repeated or excessive number of occasions that bring back the experience of some aspect of the traumatic event that cause a strong negative emotional reaction (for example, those who, due to circumstances, were first at the scene of death and are engaged in collecting of bodies and remains of the dead; police officers who repeatedly witnessed the immediate consequences of violence).
Note: the fourth point doesn’t refer to the indirect influence through the media, television, films, static images in the cases where this is not related to the performance of professional duties.
Criterion B
There is one or more symptoms of intrusion (re-experiencing a traumatic experience) associated with the traumatic event, which appeared after the traumatic event:
- Repetitive, spontaneous and intrusive memories. Children over six may channel this symptom through repetitive play that expresses aspects of the trauma.
- Traumatic nightmares or unpleasant dreams with content related to a recurring event. Children may have nightmares without trauma-related content.
- Dissociative reactions (such as flashbacks - re-experiencing a traumatic event), in which repetitive sensations occur. This can occur along a continuum of intensity, from short episodes to loss of awareness of reality. Children can re-enact events in the game.
- Severe or prolonged psychological distress when exposed to external or internal stimuli that symbolize or resemble any aspect of the traumatic event.
- It is possible to observe physiological reactivity, such as an increase in heart rate, after exposure to traumatic reminders.
Criterion C
Constantly painstakingly avoiding being reminded of the trauma after the end of the traumatic event, which is evidenced by one or both of the following signs:
- Avoiding thoughts or feelings related to the trauma.
- Avoiding external trauma reminders, such as people, places, conversations, actions, objects, or situations.
Criterion D
There is deterioration of cognitive function and mood due to a traumatic event, which began or intensified after the end of the traumatic event (at least two of the following):
- It is impossible to recall important aspects of the traumatic event (mainly due to dissociative amnesia and one that is not associated with such factors as brain trauma, alcohol or drug use).
- Persistent and exaggerated negative beliefs or expectations about oneself or the world around (For example, “I am bad”, “You can’t trust anyone”, “The world is dangerous”, “I have lost my soul forever”, “My nervous system is completely broken”).
- Persistent and distorted beliefs about the causes or consequences of a traumatic event, which are used as a basis for self-accusation or accusation of others.
- Persistent negative emotional states (for example, fear, anger, guilt or shame).
- A noticeably significant decrease in interest or involvement in the activities that were once significant.
- A feeling of detachment from other people.
- Persistent inability to experience positive emotions (for example, inability to experience happiness, satisfaction, or feelings of love and attachment).
Criterion E
A noticeable and significant change in physiological excitability and incipient or increased reactivity after the traumatic event has occurred (at least two of the following):
- Irritability or outbursts of anger (occurring for no reason or for minor reasons), usually expressed in verbal or physical aggression against people or objects.
- Self-destructive behavior, reckless risky behavior.
- Increased alertness/hypervigilance.
- Exaggerated initial reaction.
- Problems falling asleep or maintaining sleep.
- Problems concentrating.
Criterion F
The duration of the disorder (symptoms described in conditions B, C, D and E) is more than 1 month.
Criterion G
The disorder causes clinically significant distress or impairment in the person’s social, professional, or other sphere of functioning.
Criterion H
The disorder is not caused by medication, the use of psychoactive substances or other disorders and diseases.
Making a diagnosis of PTSD according to DSM-5
In order to make a diagnosis of posttraumatic stress disorder according to the DSM-5, the following criteria must be met:
- criterion А;
- one or more symptoms from criterion B;
- one or more symptoms from criterion C;
- two or more symptoms from criterion D;
- two or more symptoms from criterion E
- criterion F;
- criterion G;
- criterion H.
Diagnostic criteria of PTSD according to ICD-11
Let's look at the main and additional diagnostic criteria for PTSD according to the International Classification of Diseases and Problems Associated with Health, the Eleventh Revision (ICD-11)
Basic (mandatory) characteristics
Experiencing an event or situation (short-term or long-term) of an extremely threatening or terrifying nature.
Such events include but are not limited to the following situations:
- first-hand experience of combat operations;
- natural or man-made disasters, serious accidents, torture, sexual violence, terrorism, a seizure or an acute, life-threatening illness (for example, a heart attack);
- witnessing a threat of or an actual injury or death of other people in a sudden, unexpected or violent manner;
- news of the sudden, unexpected or violent death of a loved one.
After a traumatic event or situation, a characteristic syndrome emerges, which lasts at least several weeks and consists of 3 main elements:
- Re-experiencing a traumatic event in real time, when the event (events) is not just mentioned, but experienced as happening here and now. Usually this takes the form of vivid intrusive memories or images; flashbacks, which can vary from light (there is a fleeting feeling of the event repeating in real time) to severe (there is a complete loss of awareness of the real environment), or recurring dreams or nightmares, thematically related to the traumatic event (events). Re-experiencing is usually accompanied by strong or overwhelming emotions such as fear or terror and strong physical sensations. Re-experiencing at the same time may also include feelings of depression or immersion in the same intense emotions that were experienced during the traumatic event without a cognitive aspect and may appear in response to a reminder of the event. Reflections on the event(s) and memories of the feelings that the person experienced at the time do not qualify as re-experiencing.
- Avoiding reminders that can cause re-experiencing a traumatic event (event). This can take the form of either active internal avoidance of thoughts and memories associated with the event(s), or external avoidance of people, conversations, activities, or situations that remind of the event(s). In extreme cases, a person can change his environment (for example, move to another city or change his job) to avoid being reminded.
- A constant feeling of increased current threat, for example, in the form of increased vigilance or an increased fear response to such stimuli as unexpected noises. People with hypervigilance constantly protect themselves from danger and feel that they themselves or their loved ones are in immediate danger both in specific situations and in general. They can adopt new behaviors aimed to save them if something happens (for example, do not sit with your back to the door, constantly check the rear-view mirrors in the car).
Symptoms persist for at least several weeks and cause significant disturbances in personal, family, social, educational, professional or other important areas of functioning.
Additional clinical signs
Common symptoms of posttraumatic stress disorder may include:
- general dysphoria;
- dissociative symptoms;
- somatic complaints;
- suicidal thoughts and behavior;
- social isolation;
- excessive use of alcohol or drugs to avoid re-experiencing or to cope with emotional reactions or compulsions in response to memories or reminders of the trauma.
Emotional experiences of people with PTSD usually include anger, shame, sadness, humiliation, or guilt, including survivor’s guilt.
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