What Is Post-Traumatic Stress Disorder?

Diagnostic Criteria, Symptoms, Causes, and Treatment

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What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder involving extreme distress and disruption of daily living that happens in relation to exposure of a traumatic event. About 7 to 8% of the U.S. population will experience PTSD during their lives.

To be diagnosed with PTSD, a mental health professional would reference the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and evaluate whether or not the patient meets the criteria. The criteria in the fifth edition are somewhat different than the criteria in the fourth edition.

PTSD Symptoms

The DSM-5 outlines PTSD symptoms into four categories:

These symptoms are associated with a traumatic event. Here are the specific symptoms of PTSD, according to this criteria:

Intrusion

  • Reoccurring, involuntary, and intrusive upsetting memories of the event
  • Repeated upsetting dreams related to the event
  • You experience some type of dissociation (for example, flashbacks) where you feel as though the event is happening again
  • Strong and persistent distress to cues that are either inside or outside of your body that are connected to the event
  • Strong bodily reactions (for example, increased heart rate) when reminded of the event

Avoidance

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

Negative Changes in Thoughts and Mood

  • You can't remember an important aspect of the 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 the event
  • A pervasive negative emotional state (for example, shame, anger, or fear)
  • Loss of interest in activities that you used to enjoy
  • Feeling detached from others
  • You can't experience positive emotions (for example, happiness, love, joy)

Changes in Arousal and Reactivity

  • 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

Diagnosis

The first criteria for a diagnosis of PTSD listed in the DSM-5 is exposure to one or more traumatic event(s), which is defined as one that involved death or threatened death, actual or threatened serious injury, or actual or threatened sexual violence.

Experiencing the event could be direct, but it doesn't have to be. Exposure could also occur in the following ways, according to the DSM-5:

  • Witnessing it as it occurred to someone else
  • Learning about an event where a close friend or relative experienced an actual or threatened violent or accidental death
  • Having repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse

Once the exposure has occurred, PTSD symptoms are evaluated for a diagnosis.

DSM-5 PTSD Diagnosis

In order to be diagnosed with PTSD according to the DSM-5, the following criteria should be met:

  • Exposure to the traumatic event
  • One (or more) intrusion symptom(s)
  • One (or more) symptom(s) of avoidance
  • Two (or more) symptoms of negative changes in feelings and mood
  • Two (or more) symptoms of changes in arousal or reactivity

These symptoms also:

  • Must last for longer than one month
  • Must bring about considerable distress and/or interfere greatly with a number of different areas of your life
  • Can't be due to a medical condition or some form of substance use

Changes in the 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
  • Adding different types of exposure to the event
  • Increasing the number of symptom groups from three to four by separating avoidance symptoms into their own group
  • 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

Causes

PTSD is caused by exposure to trauma. However, it's not clear why some people develop PTSD after traumatic events while others do not. There are some risk factors that can make someone more likely to develop it than others. For example, genetics may play a role. It's also more common in women than men.

Other risk factors include:

  • A lack of social support following the event
  • An experience of past trauma
  • History of mental illness
  • History of substance use

Types

There are different types of PTSD, including:

  • Complex PTSD: Characterized by a series of traumatic events occurring over time and typically earlier in life. Notably, complex PTSD is not listed in the DSM-5.
  • Delayed expression: Before the DSM-5, this type of PTSD was referred to as "delayed onset." It occurs when someone is diagnosed at least six months after the traumatic event took place.
  • Dissociative: In addition to meeting criteria for a PTSD diagnosis, this subtype—classified specifically as "with dissociative symptoms"—requires symptoms of either depersonalization or derealization.

The DSM-5 also now lists specific criteria for the diagnosis of PTSD in young children ages 6 years and younger.

Acute stress disorder is related to PTSD. While it shares some symptoms, a PTSD diagnosis requires symptoms are present for more than a month, whereas someone with acute stress disorder could experience symptoms for just three days to one month after the traumatic event occurs.

Acute and chronic PTSD are no longer used in the DSM-5. Acute refers to PTSD symptoms lasting less than three months and chronic refers to symptoms lasting more than three months.

Treatment

Treatment for PTSD can involve medication, psychotherapy, or both. Consult a mental health professional to find the best treatment for you.

Medication

Antidepressants, or more specifically selective serotonin reuptake inhibitors (SSRIs), are typically considered the first-line medication option to treat PTSD. These can help someone with PTSD with their mood, anxiety, eating, and sleep.

Zoloft (sertraline) and Paxil (paroxetine) are FDA-approved to treat PTSD. Others that have been shown to be effective for PTSD include Prozac (fluoxetine) as well as Effexor XR (venlafaxine), which is a selective norepinephrine reuptake inhibitor (SNRI). In addition, there are other medications that may be used to treat PTSD. Be sure to discuss your options with your healthcare provider.

Psychotherapy

Cognitive behavioral therapy (CBT) is a form of talk therapy that has been found to be effective for treating the symptoms of PTSD. CBT may help manage your symptoms by working to change your beliefs and behaviors. Other types of psychotherapy that may be used for PTSD include:

Coping

PTSD gets in the way of everyday life, and it's important to take good care of yourself to manage it. Here are some ways to cope:

  • Practice mindfulness
  • Participate in a support group
  • Don't use drugs or drink alcohol
  • Exercise
  • Lean on trusted loved ones for support

If you or a loved one are struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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