diagnostic criteria

Last reviewed 01/2018

Diagnostic and Statistical Manual of Mental Disorders (DSM – V)

  • has defined traumatic event(s) required for diagnosis of PTSD:
    • exposure to actual or threatened death, serious injury, or sexual violation, in one or more of the following ways:
      • direct experiencing the traumatic event(s)
      • witnessing traumatic event(s) in others
      • learning that traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or unintentional
      • 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
        • this does not apply to exposures through electronic media, television, movies, or pictures, unless this exposure is work related
  • diagnosis of PTSD can be made when a patient displays an impaired ability to function normally for a period of one month
    • delayed presentation, in some instances years after the traumatic event, is common and in these patients the effects are severe
  • symptoms required for diagnosis include:      
    • intrusion symptoms
      • recurrent, involuntary and intrusive distressing memories
      • recurrent distressing dreams (content and/or affect related) 
      • dissociative reaction (acting or feeling as if event is recurring)
      • intense or prolonged psychological distress to cues
      • noticeable physiological reactions to cues
    • avoidance
      • avoidance or efforts to avoid distressing thoughts or feelings about or closely associated with the trauma
      • avoidance or efforts to avoid external reminders (people, places, conversations, activities, objects, situations)
    • negative alterations in cognitions and mood
      • inability to remember an important aspect (typically due to dissociative amnesia)
      • persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (for example, “I am bad,” “No one can be trusted,” “The world is completely dangerous”)
      • persistent, distorted cognitions about the cause or consequences that lead to self blame or the blame of others
      • persistent negative emotional state (for example, fear, horror, anger, guilt, shame)
      • noticeably diminished interest or participation in important activities
      • feelings of detachment or estrangement from others
      • persistent inability to experience positive emotions (for example, happiness, satisfaction, love)
    • alterations in arousal and reactivity
      • irritable behaviour and angry outbursts (with little or no provocation)
      • reckless or self destructive behaviour
      • hypervigilance
      • exaggerated startle response
      • problems with concentration
      • sleep disturbance

Proposed ICD-11

  • criterion defining traumatic event
    • exposure to and extremely threatening or horrific event or series of events
  • symptoms required for diagnosis include:
    • intrusion symptoms
      • vivid intrusive memories, flashbacks, or nightmares, typically accompanied by strong and overwhelming emotions such as fear or horror, and strong physical sensations
    • avoidance
      • avoidance of thoughts and memories of the event or events
      • avoidance of activities, situations, or people reminiscent of the event or events
    • negative alterations in cognitions and mood
      • not applicable
    • alterations in arousal and reactivity
      • persistent perceptions of heightened current threat—for example, as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises
    • additional criteria for complex PTSD
      • severe and pervasive problems in affect regulation
      • persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by deep and pervasive feelings of shame, guilt, or failure related to the stressor
      • persistent difficulties in sustaining relationships and in feeling close to others

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