Diagnostic Criteria for Post-Traumatic Stress Disorder (PTSD)
The diagnostic criteria for PTSD require exposure to trauma, followed by specific symptoms in four distinct domains: intrusion, avoidance, negative alterations in cognition/mood, and alterations in arousal/reactivity, persisting for more than one month and causing significant functional impairment. 1
Trauma Exposure Requirement
- PTSD diagnosis requires exposure to a threatening or horrific event (or series of events) 2
- Exposure can occur through:
- Direct experience of the traumatic event
- Witnessing the trauma
- Learning about trauma occurring to a close family member or friend
- Repeated or extreme exposure to aversive details of traumatic events 1
Core Symptom Clusters
1. Intrusion/Re-experiencing Symptoms (at least one required)
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event 1
- Traumatic nightmares 2, 1
- Flashbacks (dissociative reactions where the person feels or acts as if the traumatic event were recurring) 1
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble the traumatic event 1
2. Avoidance Symptoms (at least one required)
- Persistent avoidance of thoughts or feelings associated with the trauma 1
- Avoidance of external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories of the trauma 1
3. Negative Alterations in Cognition and Mood (at least two required)
- Inability to remember important aspects of the traumatic event 1
- Persistent negative beliefs about oneself, others, or the world 1
- Persistent distorted cognitions about the cause or consequences of the traumatic event 1
- Persistent negative emotional state (fear, horror, anger, guilt, or shame) 1
- Markedly diminished interest in significant activities 1
- Feelings of detachment or estrangement from others 1
- Persistent inability to experience positive emotions 1
4. Alterations in Arousal and Reactivity (at least two required)
- Irritable behavior and angry outbursts 1
- Reckless or self-destructive behavior 1
- Hypervigilance 1, 3
- Exaggerated startle response 1
- Problems with concentration 1
- Sleep disturbance 2, 1
Duration and Functional Impact
- Symptoms must persist for more than one month 1, 4
- Symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning 1, 4
Complex PTSD Considerations
- Complex PTSD develops following exposure to a threatening or horrific event (or series of events) and includes the three core features of PTSD plus:
- Severe and persistent disturbances in affect regulation
- Negative self-concept
- Difficulties in sustaining relationships 2
Assessment Tools
- The Clinician-Administered PTSD Scale (CAPS) is considered the gold standard diagnostic interview for PTSD 2, 1
- The PTSD Checklist for DSM-5 (PCL-5) can help physicians diagnose PTSD and determine symptom severity 4
Common Diagnostic Pitfalls
- Underdiagnosis is common as many patients do not voluntarily report symptoms, requiring direct screening 1
- Overlooking partial PTSD can result in untreated patients who would still benefit from treatment 1
- Failing to assess for comorbid conditions, particularly mood disorders and substance use disorders, which are extremely common in PTSD 1, 4
- Not evaluating sleep disturbances, including obstructive sleep apnea, which frequently co-occur with PTSD 2, 1
Differential Diagnosis
- Acute stress disorder (similar symptoms but duration less than one month after trauma) 4
- Major depressive disorder (overlapping symptoms but different core features) 4, 3
- Generalized anxiety disorder (difficulty determining safety from danger) 3
- Substance-induced disorders (may mimic PTSD symptoms) 4
Understanding these diagnostic criteria is essential for accurate identification and appropriate treatment of PTSD, which affects approximately 6% of the population during their lifetime 4.