DSM-5 PTSD Diagnostic Criteria

What's Changed From DSM-IV

Updated February 22, 2018
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The criteria for diagnosing post-traumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are somewhat different than the criteria in the fourth edition. Here are the symptom criteria in the DSM-5:

Criterion A

You were exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation.

In addition, these events were experienced in one or more of the following ways:

  1. You experienced the event
  2. You witnessed the event as it occurred to someone else
  3. You learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death
  4. You experienced repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse

Criterion B

You experience at least one of the following intrusive symptoms associated with the traumatic event:

  1. Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
  2. Repeated upsetting dreams where the content of the dreams is related to the traumatic event
  3. The experience of some type of dissociation (for example, flashbacks) where you feel as though the traumatic event is happening again
  4. Strong and persistent distress upon exposure to cues that are either inside or outside of your body that are connected to your traumatic event
  1. Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event

Criterion C

Frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:

  1. Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
  1. Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event

Criterion D

At least three of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:

  1. The inability to remember an important aspect of the traumatic event
  2. Persistent and elevated negative evaluations about yourself, others, or the world (for example, "I am unlovable," or "The world is an evil place")
  3. Elevated self-blame or blame of others about the cause or consequence of a traumatic event
  4. A negative emotional state (for example, shame, anger, or fear) that is pervasive
  5. Loss of interest in activities that you used to enjoy
  6. Feeling detached from others
  7. The inability to experience positive emotions (for example, happiness, love, joy)

Criterion E

At least three of the following changes in arousal that started or worsened following the experience of a traumatic event:

  1. Irritability or aggressive behavior
  2. Impulsive or self-destructive behavior
  3. Feeling constantly "on guard" or like danger is lurking around every corner (or hypervigilance)
  4. Heightened startle response
  5. Difficulty concentrating
  6. Problems sleeping

Criterion F

The above symptoms last for more than one month.

Criterion G

The symptoms bring about considerable distress and/or interfere greatly with a number of different areas of your life.

Criterion H

The symptoms are not due to a medical condition or some form of substance use.

DSM-5 PTSD Diagnosis

In order to be diagnosed with PTSD according to the DSM-5, you need to meet the following:

  • Criterion A
  • One symptom (or more) from Criterion B
  • One symptom (or more) from Criterion C
  • Three symptoms (or more) from Criterion D
  • Three symptoms (or more) from Criterion E
  • Criteria F through H

How DSM-5 Changed

The biggest change in the DSM-5 is removing PTSD from the category of anxiety disorders and putting it in a classification called "Trauma and Stressor-Related Disorders."

Other key changes include:

  • More clearly defining what kind of events are considered traumatic in Criterion A
  • Adding a fourth type of exposure in Criterion A
  • Increasing the number of symptom groups from three to four by separating avoidance symptoms into their own group (Criterion C)
  • Increasing the number of symptoms from 17 to 20
  • Changing the wording of some of the symptoms from DSM-IV
  • Adding a new set of criteria for children aged 6 or younger
  • Eliminating the "acute" and "chronic" specifiers
  • Introducing a new specifier called "dissociative features"

You can review the rationale behind these changes, as well as look at other changes in the DSM-5, at the website for the American Psychiatric Association (APA).

Sources:

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.

Friedman MJ, Resick PA, Bryant RA, Brewin CR. Considering PTSD for DSM-5. Depression and Anxiety. September 2011;28(9):750-769. doi:10.1002/da.20767.

Pai A, Suris AM, North CS. Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. Hunter SJ, ed. Behavioral Sciences. 2017;7(1):7. doi:10.3390/bs7010007.