DSM-5 PTSD Diagnostic Criteria

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.

Symptoms of PTSD

The following are the formal diagnostic criteria that need to be met in order to be diagnosed with PTSD.

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:

• Directly experiencing the event
• Witnessing the event as it occurred to someone else
• You learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death
• Experiencing 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:

• Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
• Repeated upsetting dreams where the content of the dreams is related to the traumatic event
• The experience of some type of dissociation (for example, flashbacks) where you feel as though the traumatic event is happening again
• Strong and persistent distress upon exposure to cues that are either inside or outside of your body that is connected to your traumatic event
• 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:

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

Criterion D

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

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

Criterion E

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

• Difficulty concentrating
• Feeling constantly "on guard" or like danger is lurking around every corner (or hypervigilance)
• Heightened startle response
• Impulsive or self-destructive behavior
• Irritability or aggressive behavior
• 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.

Changes in DSM-5

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 different types 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)
• Changing the wording of some of the symptoms
• Adding a new set of criteria for children aged 6 or younger
• Eliminating the "acute" and "chronic" phases
• 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).