DSM-5 PTSD Diagnostic Criteria

Helps diagnose posttraumatic stress disorder in adults and children over 6 years based on eight categories of symptoms.

Refer to the text below the calculator for more information about the positive criteria for PTSD diagnosis based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association has been updated in 2013 and now places PTSD in the “Trauma- and Stressor-Related Disorders” category, not anymore in the category of anxiety disorders (as per DSM-4).

Whilst onset of symptoms may occur immediately after the exposure, full diagnosis is usually met at around 6 months after the trauma.

DSM-5 PTSD criteria classification	PTSD positive diagnosis (all of the below)
Criterion A: stressor	≥1 (from 4) present
Criterion B: intrusion symptoms	≥1 (from 5) present
Criterion C: avoidance	≥1 (from 2) present
Criterion D: negative alterations in cognitions and mood	≥2 (from 7) present
Criterion E: alterations in arousal and reactivity	≥2 (from 6) present
Criterion F: duration	Present
Criterion G: functional significance	Present
Criterion H: exclusion	Present

Exposure

Exposure to actual or threatened death, serious injury, or sexual violence in ≥1 of the following ways:

Directly experiencing the traumatic event(s).

Witnessing, in person, the event(s) as it occurred to others.

Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

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). Note: Does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

Intrusion Symptoms

Presence of ≥1 of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.

Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific re-enactment may occur in play.

Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Avoidance

Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Negative Alterations

Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following:

Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).

Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

Markedly diminished interest or participation in significant activities.

Feelings of detachment or estrangement from others.

Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Altered Reactivity

Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following:

Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

Reckless or self-destructive behavior.

Hypervigilance.

Exaggerated startle response.

Problems with concentration.

Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F.G.H

Additional Criteria

Must meet all 3:

Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

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DSM-5 PTSD Diagnostic Criteria Explained

Diagnosis of posttraumatic stress disorder in adults and children over 6 years of age is based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association

Whilst onset of symptoms may occur immediately after the exposure, full diagnosis is usually met at around 6 months after the trauma.

Diagnostic criteria for PTSD include a history of exposure to a traumatic event along with specific stipulations and symptoms from four separate symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.

A sixth criterion concerns duration of symptoms; a seventh assesses functioning, whilst the eighth criterion confirms that symptoms are not attributable to substance use or to a co-occurring medical condition.

The table below summarizes the DSM-5 categories:

DSM-5 PTSD criteria classification	PTSD positive diagnosis	Description
Criterion A: stressor	≥1 (from 4) present	Exposure to actual or threatened death, serious injury, or sexual violence
Criterion B: intrusion symptoms	≥1 (from 5) present	Presence of intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred
Criterion C: avoidance	≥1 (from 2) present	Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred
Criterion D: negative alterations in cognitions and mood	≥2 (from 7) present	Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
Criterion E: alterations in arousal and reactivity	≥2 (from 6) present	Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
Criterion F: duration	Present	Duration of the disturbance (Criteria B, C, D and E) is more than 1 month
Criterion G: functional significance	Present	The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Criterion H: exclusion	Present	The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition

The DSM has been updated in 2013 and now places PTSD in the “Trauma- and Stressor-Related Disorders” category, not anymore in the category of anxiety disorders (as per DSM-4).

Compared to the DSM-4, the DSM-5 not only changes the wording of some symptoms but is also clearer in defining what events are considered traumatic. It also separates avoidance symptoms into their own symptom group (Criterion C). Additionally, it introduces new specifier called "dissociative features".

Reference

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

Specialty: Psychiatry

Article By: Denise Nedea

Published On: August 31, 2020 · 12:00 AM

Last Checked: August 31, 2020

Next Review: August 31, 2025