Addressing PTSD: Criteria For Diagnosis And Care Options
For many years, it was assumed that post-traumatic stress disorder (PTSD) only affected people who had been in active combat in the military. Today, however, it’s understood that PTSD can also affect those who have experienced a variety of different dangerous situations or other traumas in their lives. It’s estimated that around 6% of the US population will experience PTSD at some point in their lives.
When it comes to making an official diagnosis, mental health professionals typically compare the symptoms an individual is experiencing against the guidelines set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We’ll explore these guidelines below. Remember that an official, clinical diagnosis of any mental health disorder can only come from a licensed, qualified healthcare professional.
Criterion A
First, the individual must have experienced a traumatic incident in order for a PTSD diagnosis to be possible. The event must have involved them experiencing, witnessing, or learning that a loved one experienced actual or threatened death, serious injury, or sexual violence.
Criterion B
Next, the individual must persistently relive or re-experience the event in at least one of the following ways:
- Unwanted upsetting memories
- Flashbacks
- Nightmares
- Emotional distress when recalling the incident
- A physical reaction in response to triggers
Criterion C
The individual must also demonstrate marked avoidance of trauma-related triggers and events after the initial trauma has occurred. This may include the evasion of thoughts about the incident or people, places, or activities that remind them of it in some way.
Criterion D
In this category, the individual must experience at least two of the criteria to continue in the process towards a possible diagnosis. First, they must have negative thoughts or feelings that started or became worse after the trauma. Second, those thoughts or feelings must have changed based on:
- Their inability to recall specific aspects of the event
- Overtly negative thoughts about themselves
- Negative affect
- Decreased interest in activities once enjoyed
- Feelings of isolation
- Exaggerated self-blaming for the trauma that occurred
Criterion E
The individual must experience at least two of the criteria in this category as well to be considered for a PTSD diagnosis. First, they must experience some form of arousal or reaction that started or became worse after the trauma. This could include:
- Risky and/or destructive behavior
- Hypervigilance
- A heightened startle reflex
- Trouble sleeping
- Difficulty concentrating
- Irritability
- Aggression
Second, these feelings must be different from those that may have been felt prior to the trauma.
Criteria F–H
To meet these three criteria, the individual must have been experiencing symptoms for more than a month. These may create a level of distress or functional impairment, and they must not be related to any form of medication, substance use, or other illness.
Types of post-traumatic stress disorder (PTSD)
If a provider determines that a diagnosis of PTSD applies, they may also decide whether a subtype of the disorder is applicable. Subtypes of PTSD include:
- Dissociative specification, which means that the individual meets all of the required criteria discussed above, but also experiences either depersonalization or derealization. These additional symptoms must be considered severe.
- Delayed onset specification, which means that the symptoms that fit a PTSD diagnosis do not present until approximately six months or more after the trauma occurred. (With classic PTSD, symptoms usually present within three months of the event.) In this situation, the individual may start to feel some of the emotions and symptoms immediately, but full onset takes longer. As a result, they may be delayed in receiving an official PTSD diagnosis.
Treatment options for PTSD
If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.
Mental health treatment through cognitive behavioral therapy (CBT)
One form of therapy commonly used to treat PTSD is cognitive behavioral therapy, or CBT. A cognitive behavioral therapist can help an individual learn to recognize and shift distorted thoughts about the event they experienced and learn healthy coping mechanisms for dealing with symptoms.
Eye movement desensitization and reprocessing (EMDR) is another type of therapy that may be suggested for individuals with PTSD. It involves a therapist guiding a client through a verbal recollection of the traumatic event while having them make specific eye movements. Other types of therapy may also be recommended; meeting with a therapist for an evaluation is generally the best way to find out which type of treatment might be best for the symptoms you’re experiencing.
Seeking mental health care for PTSD symptoms
If you’re experiencing symptoms of PTSD or another mental health disorder, support is available. Meeting with a therapist or other qualified mental health care provider is typically a recommended first step, as they can evaluate your symptoms and suggest the appropriate treatment. If you’d prefer to meet with someone in person, you can search for a provider in your local area. If you’d feel more comfortable meeting with someone from the comfort of your own home or somewhere else you have a reliable internet connection, you might consider online therapy.
Processing a traumatic event with online therapy
Virtual therapy is often a more cost-effective option, and it’s more convenient for those who can’t easily leave home, have trouble locating a provider in their area, or experience anxiety at the thought of meeting with someone in person. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or online chat to address the challenges you may be facing. Research suggests that online therapy can offer similar benefits to in-person sessions, with one study indicating that it can be “a viable treatment alternative for PTSD” in particular.
Takeaway
PTSD is a serious mental health condition that may manifest as intense anxiety symptoms after undergoing or witnessing a traumatic event. In order to receive a clinical PTSD diagnosis, an individual must meet certain criteria as outlined in the DSM-V. Effective treatment for this disorder is available and typically consists of some form of psychotherapy, sometimes in combination with medication.
What are the PTSD criteria for diagnosis?
The diagnosis of post-traumatic stress disorder (PTSD) is based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is a widely accepted classification system for mental health conditions. The PTSD criteria for diagnosis included:
Criterion A: Exposure to Trauma
- The individual has been exposed to one or more traumatic events. Traumatic events are defined as:
- Directly experiencing the traumatic event.
- Witnessing the traumatic event happening to others.
- Learning that a close family member or friend experienced a traumatic event (in cases of actual or threatened death, serious injury, or sexual violence).
Criterion B: Intrusion Symptoms
The individual experiences one or more of the following intrusion symptoms, associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, distressing memories of the event(s).
- Distressing dreams related to the event(s).
- Flashbacks or a sense of reliving the traumatic event(s).
- Intense or prolonged psychological distress or physiological reactions when exposed to reminders of the event(s).
Criterion C: Avoidance
The individual deliberately avoids reminders of the traumatic event(s), including thoughts, feelings, conversations, places, people, activities, or objects associated with the event(s).
Criterion D: Negative Changes in Mood and Cognition
- The individual experiences negative changes in mood and cognition associated with the traumatic event(s), which may include:
- Inability to remember important aspects of the traumatic event(s).
- Persistent and exaggerated negative beliefs about oneself, others, or the world.
- Persistent distorted thoughts about the cause or consequences of the event(s).
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feeling detached from others or experiencing a sense of emotional numbness.
Criterion E: Alterations in Arousal and Reactivity
- The individual exhibits marked alterations in arousal and reactivity associated with the traumatic event(s), which may include:
- Irritability or angry outbursts.
- Reckless or self-destructive behavior.
- Hypervigilance.
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbances.
Criterion F: Duration of Symptoms
The disturbance (symptoms) lasts for more than one month.
Criterion G: Functional Impairment
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion H: Exclusion of Other Conditions
The symptoms are not due to the effects of a substance (e.g., medication, drugs, alcohol) or another medical condition.
To receive a diagnosis of PTSD, an individual must meet all criteria (A to H) as outlined in the DSM-5. Additionally, the severity of the disorder can be specified as "with dissociative symptoms" if the individual experiences depersonalization or derealization during or after the traumatic event(s). It's important to note that a diagnosis should be made by a qualified mental health professional based on a comprehensive evaluation of the individual's symptoms and history.
What is the DSM-5 criteria and code for PTSD?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines the criteria for diagnosing post-traumatic stress disorder (PTSD) and assigns a specific code for this condition. The DSM-5 criteria for PTSD are as follows:
- Criterion A: Exposure to Trauma
- Criterion B: Intrusion Symptoms
- Criterion C: Avoidance
- Criterion D: Negative Changes in Mood and Cognition
- Criterion E: Alterations in Arousal and Reactivity
- Criterion F: Duration of Symptoms
- Criterion G: Functional Impairment
- Criterion H: Exclusion of Other Conditions
The DSM-5 code for post-traumatic stress disorder is 309.81.
Is C-PTSD a form of BPD?
Complex post-traumatic stress disorder (C-PTSD) and borderline personality disorder (BPD) are two distinct mental health conditions, although they can have some overlapping symptoms and characteristics. It's important to differentiate between the two:
Complex post-traumatic stress disorder (C-PTSD):
C-PTSD is a condition that arises as a result of prolonged and repeated or extreme exposure to trauma, often during childhood or in situations of chronic abuse, neglect, or captivity. It is characterized by symptoms similar to those of traditional post-traumatic stress disorder (PTSD), such as flashbacks, nightmares, and hypervigilance. However, C-PTSD includes additional features such as difficulties in emotional regulation, problems with forming and maintaining relationships, and a negative self-concept. C-PTSD, PTSD, and Acute Stress Disorder are all labeled as stressor-related disorders in the DSM-5, while BPD is classified as a personality disorder.
Borderline personality disorder (BPD):
BPD is a distinct personality disorder characterized by pervasive and enduring patterns of instability in mood, self-image, interpersonal relationships, and impulsivity. Individuals with BPD often experience intense mood swings, fear of abandonment, self-destructive behaviors, and difficulties with identity. Individuals with BPD may experience positive emotions followed by negative emotions in rapid succession. While trauma and adverse experiences may contribute to the development of BPD in some cases, it is primarily categorized as a personality disorder in the DSM-5, rather than a trauma-related disorder like C-PTSD.
Are the symptoms of C-PTSD similar to those of autism spectrum disorder?
Complex post-traumatic stress disorder (C-PTSD) and autism spectrum disorder (ASD) are distinct conditions with different underlying causes, although they can sometimes have certain behavioral and social characteristics. It's important to differentiate between the two:
Complex post-traumatic stress disorder (C-PTSD):
C-PTSD is a mental health condition that can develop in response to prolonged and severe trauma, often occurring during childhood or as a result of chronic abuse, neglect, or captivity. It is characterized by a range of symptoms, including emotional dysregulation, difficulties in forming and maintaining relationships, and a negative self-concept. Individuals with C-PTSD may experience hypervigilance, nightmares, and flashbacks similar to those with post-traumatic stress disorder (PTSD), but they also exhibit other complex symptoms related to the impact of prolonged trauma.
Autism spectrum disorder (ASD):
ASD is a neurodevelopmental disorder that is present from early childhood and primarily characterized by difficulties in social interaction and communication, as well as restricted and repetitive patterns of behavior, interests, or activities. Individuals with ASD may have challenges in understanding social cues, making eye contact, engaging in reciprocal conversations, and may engage in repetitive behaviors or have highly focused interests.
Is dissociation a symptom of C-PTSD?
Yes, complex post-traumatic stress disorder (C-PTSD) can often involve dissociation as one of its symptoms. Dissociation is a psychological defense mechanism that involves a disconnection or detachment from one's thoughts, feelings, identity, or consciousness. It can manifest in various ways and may serve as a coping mechanism in response to severe and prolonged trauma.
What are the 17 symptoms of PTSD?
According to the Substance Abuse and Mental Health Services Administration, PTSD can impact many areas of an individual’s life and the symptoms may vary widely between individuals. 17 symptoms commonly associated with post-traumatic stress disorder (PTSD) include:
- Recurrent, distressing memories of the traumatic event(s).
- Distressing dreams related to the traumatic event(s).
- Flashbacks or a sense of reliving the traumatic event(s).
- Intense psychological distress or physiological reactions when exposed to reminders of the event(s).
- Avoidance of distressing memories, thoughts, or feelings associated with the event(s).
- Avoidance of external reminders, such as places, people, conversations, or activities, that trigger distressing memories or feelings.
- Inability to remember important aspects of the traumatic event(s).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
- Persistent distorted thoughts about the cause or consequences of the traumatic event(s).
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feeling detached from others or experiencing a sense of emotional numbness.
- Irritability, angry outbursts, and verbal or physical aggression with little or no provocation.
- Reckless or self-destructive behavior.
- Hypervigilance (constantly being on guard).
- Exaggerated startle response.
- Problems with concentration.
Individuals experiencing these symptoms may benefit from professional support from a trained and licensed therapist. In addition to the symptoms above, PTSD may also be present in individuals who experience substance abuse disorders. If this is the case treatment may involve a multipronged approach involving both substance abuse treatment and PTSD treatment at the same time.
What criteria related to a traumatic event must be met for a diagnosis of PTSD?
To receive a diagnosis of post-traumatic stress disorder (PTSD), an individual must meet two key criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) from the American Psychiatric Association:
Criterion A: Exposure to trauma
The individual has been exposed to one or more traumatic events. Traumatic events are defined as:
- Directly experiencing the traumatic event.
- Witnessing the traumatic event happening to others.
- Learning that a close family member or friend experienced a traumatic event (in cases of actual or threatened death, serious injury, or sexual violence).
Criterion B: Presence of specific symptoms
The individual must experience specific symptoms associated with the traumatic event(s).
These symptoms are divided into four clusters:
- Cluster B: Intrusion Symptoms: Symptoms related to intrusive experiences such as distressing memories, nightmares, flashbacks, or intense psychological distress when exposed to reminders of the event(s).
- Cluster C: Avoidance: Symptoms related to efforts to avoid reminders of the traumatic event(s), including avoidance of distressing memories, thoughts, feelings, or external reminders.
- Cluster D: Negative Alterations in Mood and Cognition: Symptoms related to persistent and exaggerated negative beliefs, distorted thoughts, negative emotions, diminished interest in activities, and feeling detached from others.
- Cluster E: Alterations in Arousal and Reactivity: Symptoms related to increased arousal and reactivity, including irritability, reckless behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbances.
In addition to meeting these two criteria, the diagnosis of PTSD also requires that the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F and G). Furthermore, the symptoms must not be due to the effects of a substance (e.g., medication, drugs, alcohol) or another medical condition (Criterion H).
What is the gold standard test for PTSD?
There isn't a single "gold standard" test for diagnosing post-traumatic stress disorder (PTSD). Instead, the diagnosis of PTSD typically involves a comprehensive clinical assessment conducted by a qualified mental health professional. This assessment may include a combination of clinical interviews, self-report questionnaires, and psychological evaluations.
How did the diagnostic criteria for PTSD change from the DSM-4 to the DSM-5?
The diagnosis of post-traumatic stress disorder (PTSD) underwent significant changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), compared to previous editions (e.g., DSM-IV).
Post-traumatic stress disorder or (PTSD) criteria for diagnosis
Some key differences in how PTSD is defined and diagnosed in the DSM-5 include:
- Revised Criteria: The DSM-5 introduced a reorganization and renaming of the full diagnostic criteria. Instead of three symptom clusters in the DSM-IV (re-experiencing, avoidance, and arousal), the DSM-5 categorizes symptoms into four clusters: intrusion symptoms, avoidance, negative alterations in mood and cognition, and alterations in arousal and reactivity.
- Criterion A: The definition of the traumatic event (Criterion A) was broadened. While the DSM-IV required that the individual experience, witness, or be confronted with an event that involved actual or threatened death or serious injury, the DSM-5 expanded this definition to include exposure to sexual violence as well.
- Symptom Clusters: The symptom clusters were redefined and expanded in the DSM-5. For example, intrusion symptoms now include not only flashbacks and nightmares but also distressing memories of the traumatic event(s). The arousal and reactivity cluster was broadened to include symptoms such as reckless or self-destructive behavior.
- Duration: The duration of symptoms required for diagnosis changed. In the DSM-IV, symptoms needed to persist for at least one month. In the DSM-5, symptoms must persist for more than one month.
- New Category: Dissociative Subtype: The DSM-5 introduced a dissociative subtype of PTSD, which recognizes the presence of depersonalization and derealization symptoms in individuals with PTSD.
- Removed Criterion: Response to Triggers: The DSM-5 removed the criterion that required the individual to have a "response to triggers" associated with the traumatic event(s). Instead, it emphasizes that intrusive memories or symptoms are triggered by the traumatic event itself.
- Subthreshold PTSD: The DSM-5 acknowledges a "subthreshold" or "partial" PTSD diagnosis for individuals who do not meet the full criteria but still experience significant distress and impairment due to trauma-related symptoms.
These changes in the DSM-5 reflect an updated understanding of PTSD and aim to provide a more comprehensive and accurate framework for diagnosing and assessing the disorder. The changes were made to better capture the complex and varied experiences of individuals who have been exposed to traumatic events. Mental health professionals use the DSM-5 criteria to diagnose and treat individuals with PTSD.
What is the best test for PTSD?
There isn't a single "best" test for diagnosing post-traumatic stress disorder (PTSD) because the diagnosis of PTSD typically involves a comprehensive clinical assessment conducted by a qualified mental health professional. This assessment may include a combination of clinical interviews, self-report questionnaires, and psychological evaluations. These tests may identify internal or external cues to help identify PTSD.
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