What are the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD)?

From the Guidelines

The diagnosis of post-traumatic stress disorder (PTSD) requires exposure to a traumatic event, such as actual or threatened death, serious injury, or sexual violence, followed by specific symptoms lasting for more than one month and causing significant distress or functional impairment. The symptoms must fall into four categories:

• Intrusion symptoms, such as repeated distressing memories and/or dreams (nightmares) about the traumatic event, dissociation, and flashbacks 1
• Avoidance of trauma-related stimuli, including attempts to avoid distressing memories, thoughts, feelings, activities, and/or places that remind the individual of the traumatic event 1
• Negative alterations in cognition and mood, including problems remembering important aspects of the traumatic event, negative beliefs or expectations about oneself, others, or the world, and negative emotional states such as depression 1
• Alterations in arousal and reactivity, including irritable and angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance 1. A thorough clinical assessment by a qualified mental health professional is essential for diagnosis, as symptoms can overlap with other conditions like depression or anxiety disorders, and early diagnosis is crucial to prevent chronicity and to initiate effective treatments, such as trauma-focused psychotherapies and medications 1.

From the FDA Drug Label

PTSD, as defined by DSM-IV, requires exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others, and a response that involves intense fear, helplessness, or horror Symptoms that occur as a result of exposure to the traumatic event include reexperiencing of the event in the form of intrusive thoughts, flashbacks, or dreams, and intense psychological distress and physiological reactivity on exposure to cues to the event; avoidance of situations reminiscent of the traumatic event, inability to recall details of the event, and/or numbing of general responsiveness manifested as diminished interest in significant activities, estrangement from others, restricted range of affect, or sense of foreshortened future; and symptoms of autonomic arousal including hypervigilance, exaggerated startle response, sleep disturbance, impaired concentration, and irritability or outbursts of anger A PTSD diagnosis requires that the symptoms are present for at least a month and that they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

To make a diagnosis of Posttraumatic Stress Disorder (PTSD), the following requirements must be met:

• Exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others
• A response that involves intense fear, helplessness, or horror
• Symptoms must be present for at least a month
• Symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Symptoms must include at least some of the following:
  • Reexperiencing of the event in the form of intrusive thoughts, flashbacks, or dreams
  • Avoidance of situations reminiscent of the traumatic event
  • Numbing of general responsiveness
  • Autonomic arousal including hypervigilance, exaggerated startle response, sleep disturbance, impaired concentration, and irritability or outbursts of anger 2

From the Research

Diagnostic Criteria for Post Traumatic Stress Disorder

To make a diagnosis of post traumatic stress disorder (PTSD), the following criteria must be met:

• The individual must have experienced a traumatic event involving the threat of death or harm to physical integrity 3
• Symptoms must include trauma-related intrusive thoughts, avoidant behaviors, negative alterations of cognition or mood, and changes in arousal and reactivity 3
• The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision provides diagnostic criteria, and the PTSD Checklist for DSM-5 uses these diagnostic criteria to help physicians diagnose PTSD and determine severity 3

Assessment Tools

Several assessment tools can be used to diagnose PTSD, including:

• The PTSD Checklist for DSM-5 3
• Evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time 4

Key Considerations

When diagnosing PTSD, it is essential to consider the following:

• Assessing for past trauma in patients with anxiety or other psychiatric illnesses may aid in diagnosing and treating PTSD 3
• Psychiatric comorbidities, particularly mood disorders and substance use, are common in PTSD and are best treated concurrently 3
• Sleep disturbance related to hyperarousal or nightmares is common in PTSD, and prazosin may be effective for treatment 3