PTSD Criteria Explained

Mental health professionals use a manual called the DSM-V in order to list the criteria and diagnose mental health disorders. It can be difficult to understand so I've consolidated and outlined the criteria for PTSD in the following article to make for easy reading.

Criteria A: (One required)

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual threatened violence in the following way (s):

  • Direct Exposure

  • Witnessing the trauma

  • Learning that a traumatic event occurred to a relative or close friend

  • Indirect exposure to adverse details of the trauma, usually in the course of professional duties (first responders, medics, etc.)

Criteria B: Intrusive Symptoms (One required)

The traumatic event is persistently re-experienced in the following way (s):

  • Unwanted, Upsetting Memories- Thoughts of the trauma come into your mind that may cause sadness, anger, frustration and fear. The thoughts can last minutes, hours, days, etc. They seem to be debilitating and interfere with daily functioning.

  • Nightmares: You experience nightmares with themes of fear, death, injury, guilt, helplessness and panic. Nightmares don’t necessarily have to replicate the trauma but often do. A recent article on Vietnam Veterans found that the emotional content of the nightmares included: 90% involved feelings of helplessness, 85% contained fear, 42% contained confusion, 27% involved sadness and 23% involved disgust (Harb, et al., 2012). The same study found that sensory details could be included with war veterans including sounds, smells, colors and sensations (Harb, et al., 2012).

  • Flashbacks: Reliving the trauma experience through illusions, hallucinations or flashbacks. During the flashback you may stay connected to the present moment or may lose all awareness of your current surroundings or situation. Reminders of the traumatic event can trigger flashbacks.

  • Emotional distress after exposure to traumatic reminders: Emotional responses (anger, sadness, fear, etc) when you are exposed to triggering events that resemble or symbolize a traumatic event. Example: Entering a bank for a woman who was held hostage in a bank.

  • Physical reactivity after exposure to traumatic reminders: Upset stomach, sweating, racing heartbeat, rapid breathing, headache, etc.

Criteria C: Avoidance (One required)

  • Avoidance of trauma related stimuli: Avoiding thoughts, feelings, or physical sensations that elicit memories of the trauma

  • Avoidance of trauma related external reminders: Avoiding places, people, situations, conversations, activities, objects that elicit memories of the trauma.

Criteria D: Negative cognitions and mood (Two required):

Negative changes in thoughts or mood that began or worsened after the trauma in the following way(s)

  • Inability to remember important features of the trauma: this type of dissociative amnesia makes it difficult to remember details of the trauma.

  • Negative thoughts about oneself or the world. For example: “I’m a disgrace”, “No one loves me”, “The world is awful/terrible”

  • Blaming oneself or others for the trauma. For example: “I shouldn’t have put myself in that situation” or “I should have…”

  • A negative emotional state (e.g., anger, sadness, fear, guilt, shame)

  • Loss of interest in activities. For example: You have no desire to participate in activities that you used to enjoy. This may also include doing activities with family and friends that you used to enjoy being around.

  • Feeling detached or isolated from others. You may feel distant from others, even with people you were close to before the trauma. You may even feel unconcerned with people in your life

  • Inability to experience positive emotions: You may have a very difficult time experiencing happiness, joy, satisfaction, intimacy, etc.

Criteria E: Arousal and Reactivity (Two required):

  • Irritable behavior and angry outbursts: These outbursts are not provoked but may result in you yelling at others, getting into fights, breaking items, destroying objects, road rage

  • Risky or destructive behavior: You may engage in reckless behavior including drunk driving, gabling excessively, alcohol and drug use, self-harming (hitting self, cutting self, etc) or risky sexual behavior.

  • Hypervigilance: You are “on guard” and can seem to resemble paranoia. You have an increased awareness to your surroundings and are sensitive to potential threats

  • Heightened startle reaction: You may be very reactive to stimuli and seem “jumpy” with sudden movements, loud noise. For example, a veteran may jump down when he hears fireworks or a loud noise.

  • Difficulty concentrating: You may have trouble remembering dates and staying focused during conversations and activities.

  • Difficulty sleeping: Insomnia, difficulty staying asleep and/or nightmares.

Criteria F: Required

  • Symptoms last for more than 1 month

Criteria G: Required

  • Your PTSD symptoms cause major impairment in your ability to function in social, work, school and other important areas.

Criteria H: Required

  • PTSD symptoms are not due to medication, alcohol use, drug use or other illnesses.

Please note that the criteria for children ages 6 and under is slightly different. Please see your therapist or psychiatrist for more details.

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