How A Professional Comes To A PTSD Diagnosis

According to the US Department of Veteran Affairs, roughly 6% of the US population will experience post-traumatic stress disorder (PTSD) at some point in their lives. Despite its prevalence, this mental health condition is somewhat misunderstood, leading many people to try and cope with their symptoms alone. Understanding the seriousness of this illness and seeking a clinical diagnosis and treatment can be crucial for reducing symptoms and improving health and well-being. Read on for information about post-traumatic stress disorder, including who can diagnose PTSD, the basics of the process, and treatment options that may help a person manage PTSD symptoms.

What is post-traumatic stress disorder?

According to the National Institute of Mental Health, post-traumatic stress disorder is a mental illness that can develop in some people that have witnessed or experienced a traumatic event. Not everyone that experiences a traumatic event develops PTSD, but everyone with PTSD has experienced or witnessed a traumatic event. This illness can affect children, teenagers, and adults.

Key PTSD symptoms

The way PTSD manifests in a given individual can vary, but symptoms generally include at least some of the following:

• Intrusive memories 
• Involuntary recurrent memories that feel real (flashbacks) 
• Reluctance to talk about the traumatic event
• Avoidance of people, places, objects, or discussions associated with the event
• Difficulty remembering details associated with the event
• A heightened emotional state
• Lack of interest in activities previously enjoyed
• Feelings of detachment, anger, or hypervigilance  
• Difficulty experiencing positive emotions
• Engaging in substance misuse (formerly known as “substance abuse”) to cope with symptoms
• Difficulty concentrating
• Sleep problems (trouble sleeping, nightmares)
• Depersonalization or derealization

What causes post-traumatic stress disorder? 

PTSD is generally caused by witnessing or experiencing a life-threatening event or an otherwise traumatic situation. Some examples of events that could potentially lead to PTSD (or complex PTSD, if repeated/ongoing) include the following: 

• The death of a loved one
• A near-death experience 
• Domestic violence 
• Neglect
• Separation from loved ones
• A serious accident
• A severe injury
• A medical procedure or hospitalization 
• Receiving a serious threat
• A natural disaster
• Sexual assault 
• A public shooting 
• Seeing another person be abused or otherwise harmed 

Some people believe that post-traumatic stress disorder only affects those that see or experience a traumatic event first-hand. However, some people (such as journalists) may experience PTSD after witnessing an event through photos/videos or by conversing or writing about it repeatedly or at length. Also consider research indicating that a person may be more likely to develop PTSD after a traumatic event due to certain genetic factors.

Identifying post-traumatic stress disorder

The process of didentifying PTSD must generally be performed by some type of qualified clinician. Primary care doctors, psychiatrists, clinical psychologists, and clinical mental health counselors or therapists are typically qualified to identify PTSD. Remember that while online PTSD tests and articles can be a useful source of information, they are not an adequate substitute for evaluation from a licensed mental health professional. 

The steps of a PTSD diagnosis

The first steps usually happen in one of two ways. An individual may suspect they have PTSD and seek confirmation from a professional. Or, they might decide to or be encouraged by friends or family members to seek support for symptoms that are impacting their daily life without realizing they may indicate PTSD. Upon evaluation, a clinician may confirm PTSD.

Clinicians generally have to rely on psychological evaluation and interviews rather than explicit tests. Many health conditions are discovered through biological markers. For example, if a doctor suspects that a patient has strep throat, they’ll typically do a swab and test it to get confirmation. However, identification of a mental illness like PTSD can only be made based on a person's self-reported symptoms, conversations with loved ones, and the clinician ruling out other possible mental health conditions or medical causes. 

Clinicians may use two tools in this process to help them decide if a PTSD diagnosis may be suitable for a given client:

1. The Diagnostic and Statistical Manual of Mental Disorders (DSM)
2. Research-backed screening tests or questionnaires for identifying and measuring PTSD symptoms (typically reserved for professional use only)

Based on the results of interviews and any screening tests, the clinician will determine how well the client’s symptoms fit into the DSM's criteria. If they align, a PTSD diagnosis may be made.

The role of the DSM

The most recent version of the DSM is called the DSM-5, published by the American Psychiatric Association in 2013. Clinicians in the US often consider it the top authority when it comes to identifying and treating mental health conditions. 

The DSM organizes mental illnesses into categories, such as depressive disorders (major depression, perinatal depression, seasonal affective disorder, etc.) or anxiety disorders (specific phobias, generalized anxiety disorder, panic disorder, etc.). In the DSM-5, post-traumatic stress disorder is categorized as a “trauma and stressor-related disorder” along with reactive attachment disorder, acute stress disorder, adjustment disorder, and others. As the category title implies, the conditions with this label all stem from exposure to trauma or stress.

Clinicians may use the DSM-5 to determine the correct category of mental illness and the correct treatment options for a specific condition within that category. 

Post-traumatic stress disorder criteria according to the DSM-5

The DSM-5 lists a specific set of criteria that must match a client’s symptoms in order for PTSD to be considered. The first one is age, as the DSM-5 has different criteria for PTSD in those under the age of six and over the age of six. For those older than six, the following criteria must be met for PTSD to potentially apply.

Having experienced or witnessed a traumatic event

To be identified as having PTSD, a client must have been exposed to or experienced a perceived threat of death, serious injury, sexual violence, or other trauma. PTSD might not be noted if someone witnessed the event via pictures, television, or movies unless the exposure was a part of their work (like a first responder or journalist), consistently occurring, or connected to other traumatic events. 

The presence of intrusive re-experiencing symptoms 

Clients must experience one or more "intrusion symptoms" following the event. Intrusion symptoms are those that take the client back to the original event and come up unexpectedly. These may include flashbacks, nightmares, intrusive thoughts, or frightening memories. 

The presence of avoidant symptoms 

The client must also demonstrate avoidance symptoms and behaviors related to the traumatic event. For example, they may try not to think about or go to places associated with the event, or they may shut down during conversations about what occurred. 

The presence of negative beliefs/thoughts and distressing emotions 

A clinician suspecting PTSD will also evaluate their client for depressed thoughts or negative moods following the event. They might also look for mood symptoms like increased agitation, aggression, hypervigilance, an exaggerated startle response, and other reactivity symptoms. A PTSD identification requires at least two examples of these changes to be present in a client's daily life. 

Specific symptom duration

The clinician will also aim to find out how long a person has been experiencing their symptoms. The DSM-5 considers a diagnosis of PTSD to be valid if a client reports experiencing symptoms for at least one month or longer. If not, another identification such as acute stress disorder may apply.

Why is identification important? 

Seeking out a clinical diagnosis from a qualified healthcare provider can have a few potential benefits for the individual experiencing symptoms, including the following.

Streamlined communication 

An official diagnosis may help streamline communications between medical professionals on a client’s care team. For example, a doctor referring a patient to a psychiatrist to discuss medication for PTSD could include this information in their referral so the psychiatrist knows what to expect and can better serve the client. 

Resources 

Having an official diagnosis may also make it easier for people with PTSD to seek out support resources. Experiencing a set of unexplained and unidentified symptoms can make reaching out for help more difficult, in some cases. 

Treatment options

A traumatic stress disorder like PTSD may respond to a variety of treatments depending on the individual and their unique situation. Some examples of potentially effective treatments for PTSD include some form of psychotherapy (also called talk therapy), group therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR). Therapy may sometimes be recommended in combination with anti-anxiety medications or selective serotonin reuptake inhibitors (SSRIs) and certain lifestyle changes. 

Remember that symptoms of this illness typically won’t resolve on their own without PTSD treatment, and they can have serious effects if not properly addressed. That’s why speaking with a healthcare provider about what kind of treatment approach might be right for you can be important. 

How to find support after a traumatic event

PTSD can be treated by a professional with a degree in clinical psychology, a clinical social worker, or another licensed professional practicing psychotherapy. Finding such a provider with training and experience in treating trauma-related disorders can be especially valuable. Trauma-informed providers are those that have worked with clients with PTSD or related conditions before and have been trained in how trauma can impact the mind and body.  

If you’re living with symptoms of PTSD, it can be difficult to find the energy to search for in-person care providers near you and then travel to and from in-office appointments. You might also feel stressed at the prospect of opening up to someone about your trauma face to face. This is a situation in which online therapy may be especially convenient. Plus, research suggests that online therapy can be as beneficial as in-person therapy in many cases.

Those looking to receive mental health support from home might consider connecting with a therapist through an online therapy platform like BetterHelp. You can fill out a simple questionnaire to get matched with a licensed therapist that suits your needs and preferences. Then, you can meet with them virtually via phone or video call—whatever makes you feel more comfortable—from anywhere you have an internet connection.