Diagnostic Criteria for Post-Traumatic Stress Disorder (PTSD)
The diagnostic criteria for PTSD include exposure to a traumatic event followed by symptoms across four distinct clusters: intrusion/re-experiencing, avoidance, negative alterations in cognition and mood, and increased arousal and reactivity, which persist for at least one month and cause significant functional impairment. 1
Core Diagnostic Requirements
1. Trauma Exposure
- Exposure to actual or threatened death, serious injury, or sexual violence through:
- Direct experience
- Witnessing the event
- Learning about the event occurring to a close family member/friend
- Experiencing repeated or extreme exposure to aversive details of traumatic events
2. Symptom Clusters (must persist for at least 1 month)
A. Intrusion/Re-experiencing
- Recurrent, involuntary, and intrusive distressing memories
- Traumatic nightmares
- Dissociative reactions (flashbacks) where the person feels or acts as if the event is recurring
- Intense or prolonged psychological distress at exposure to trauma-related cues
- Marked physiological reactions to trauma-related stimuli 2
B. Avoidance
- Persistent avoidance of distressing memories, thoughts, or feelings related to the trauma
- Avoidance of external reminders (people, places, conversations, activities) that arouse distressing memories 2
C. Negative Alterations in Cognition and Mood
- Inability to remember important aspects of the traumatic event
- Persistent negative beliefs about oneself, others, or the world
- Distorted thoughts about the cause or consequences leading to self-blame or blame of others
- Persistent negative emotional state
- Diminished interest in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions 2, 1
D. Increased Arousal and Reactivity
- Irritable behavior and angry outbursts
- Reckless or self-destructive behavior
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance 2, 1
3. Duration and Impairment
- Symptoms persist for more than one month
- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning 1, 3
Assessment Tools
- PTSD Checklist for DSM-5 (PCL-5) is recommended to track progress across specific symptom clusters 1, 3
- Structured clinical interviews can provide more comprehensive assessment 4
Differential Diagnosis Considerations
- Acute Stress Disorder (similar symptoms but duration less than one month)
- Adjustment Disorder
- Major Depressive Disorder
- Anxiety Disorders
- Substance-induced disorders 1, 3
Special Considerations
Complex PTSD
- Recognized in ICD-11 but not in DSM-5
- Characterized by the core features of PTSD plus severe and persistent disturbances in:
- Affect regulation
- Negative self-concept
- Difficulties in sustaining relationships 2
Cultural Factors
- Cultural syndromes may influence symptom presentation and attribution
- Cultural background affects how individuals perceive and report trauma-related symptoms
- Assessment should consider cultural variations in the expression of distress 2, 1
Comorbidities
- High rates of comorbidity with mood disorders, anxiety disorders, and substance use disorders
- These comorbidities should be assessed and treated concurrently for optimal outcomes 1, 3, 5
Prevalence and Risk
- Lifetime prevalence of approximately 6-10% in the general population
- More than 70% of adults worldwide experience at least one traumatic event in their lifetime
- Approximately 10% of individuals develop PTSD after experiencing a traumatic event 3, 5
Understanding these diagnostic criteria is essential for accurate identification and appropriate treatment planning for individuals suffering from PTSD, which typically includes trauma-focused psychotherapy as first-line treatment, with medication as an adjunctive approach when needed.