To be diagnosed with Post-Traumatic Stress Disorder (PTSD) using DSM-5, the following criteria must be met:

Criterion A: Exposure to Trauma The individual has been exposed to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

  • Direct exposure: The person directly experienced the traumatic event.
  • Witnessing: The person witnessed the traumatic event happening to others.
  • Indirect exposure: The person learned that a close relative or friend experienced a traumatic event, and the event had a significant impact on the individual. This can include repeated or extreme exposure to details of traumatic events, such as in the case of first responders.

Criterion B: Intrusive Symptoms The individual experiences intrusive symptoms, which are distressing and may include:

  • Recurrent, distressing memories of the traumatic event.
  • Recurrent, distressing dreams related to the traumatic event.
  • Dissociative reactions (flashbacks) where the individual feels as if the traumatic event is happening again.
  • Intense psychological distress or physiological reactions when exposed to cues that resemble an aspect of the traumatic event.

Criterion C: Avoidance The individual actively avoids reminders associated with the traumatic event, which can include:

  • Avoiding thoughts, feelings, or conversations related to the trauma.
  • Avoiding people, places, or activities that are reminders of the trauma.

Criterion D: Negative Alterations in Cognition and Mood The individual experiences negative alterations in mood and cognition associated with the trauma, such as:

  • Inability to remember key aspects of the traumatic event (dissociative amnesia).
  • Persistent and exaggerated negative beliefs or expectations about oneself or others (e.g., "I am bad," "No one can be trusted").
  • Persistent distorted thoughts about the cause or consequences of the traumatic event leading to self-blame or blaming others.
  • Persistent negative emotional state, like fear, horror, anger, guilt, or shame.
  • Decreased interest or participation in significant activities.
  • Feelings of detachment from others.
  • Inability to experience positive emotions (anhedonia).

Criterion E: Alterations in Arousal and Reactivity The individual experiences alterations in arousal and reactivity, including:

  • Irritability and outbursts of anger.
  • Reckless or self-destructive behavior.
  • Hypervigilance (excessive alertness) and heightened startle response.
  • Problems with concentration.
  • Sleep disturbances (e.g., difficulty falling asleep or staying asleep).

Criterion F: Duration of Symptoms The symptoms in Criteria B, C, D, and E have persisted for more than one month.

Criterion G: Functional Significance The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion H: Exclusion of Other Disorders The symptoms cannot be attributed to medication, substance use, or other medical conditions.

Specify if:

  • With Dissociative Symptoms: This specifier is used if the individual experiences depersonalization or derealization in response to the trauma.

  • Specify if:

    • With Delayed Expression: This specifier is used if the full diagnostic criteria are not met until at least six months after the traumatic event.

Practice Question

How well do you understand PTSD criteria? Here's a quick practice question to test your knowledge:

A social worker is conducting an assessment with a new client who has recently experienced a traumatic event. The client reports recurring nightmares, hypervigilance, and severe emotional distress when reminded of the trauma. The client also expresses feelings of guilt and blames themselves for the event.  Which crucial criteria from the DSM-5 for diagnosing PTSD is the client currently meeting?

A. Intrusive symptoms

B. Avoidance

C. Negative alterations in cognition and mood

D. Alterations in arousal and reactivity

What's your answer?

The client's recurring nightmares, hypervigilance, and emotional distress when reminded of the trauma align with Criterion B in the DSM-5--Intrusive symptoms. While the client also expresses feelings of guilt, the emphasis in this scenario is on intrusive symptoms.

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October 11, 2023
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