Who Can Diagnose PTSD?
Post-traumatic stress disorder (PTSD) is a serious mental illness that can develop after a person has experienced a traumatic event. Symptoms of PTSD can exist on a spectrum but may evolve in ways that significantly disrupt a person’s life and ability to function.
If you suspect you might have PTSD, you may be curious about the process of receiving a PTSD diagnosis. PTSD is typically diagnosed by a licensed mental health professional, using an assessment based on a set of diagnostic criteria developed by psychology researchers. Receiving a diagnosis can be a fundamental part of beginning the treatment process and taking steps toward healing from trauma.
How is PTSD diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), lays out clear criteria for a post-traumatic stress disorder diagnosis. First, a person generally needs to have had one of the following experiences related to a traumatic event:
- Lived through the event themselves
- Witnessed the event happening to others
- Had a close friend or family member experience the event
- Experienced repeated and extreme exposure to the event without directly experiencing it themselves (common in healthcare personnel, first responders, social workers, media reporters, etc.)
If a person has experienced one or more traumatic events, they can then be screened for a variety of PTSD symptoms. The DSM-V divides PTSD symptoms into four categories: intrusive symptoms, avoidance symptoms, cognition/mood symptoms, and arousal/reactivity symptoms. To receive a PTSD diagnosis, a person usually needs to demonstrate the symptom patterns described below.
One or more intrusive symptoms:
- Recurrent memories of the event
- Recurrent nightmares related to the event
- Flashbacks, or dissociative reactions in which a person believes and acts as though the traumatic event were recurring (occurring on a spectrum, with the most severe form involving the total loss of a person’s awareness of their current surroundings)
One or more avoidance symptoms:
- Efforts to avoid internal stimuli associated with the event, such as thoughts, memories, or feelings related to the trauma
- Efforts to avoid external stimuli related to the event, such as people, places, conversations, activities, objects, or situations associated with the trauma
Two or more mood- and cognition-related symptoms:
- Difficulty remembering all or part of the traumatic event
- Persistent and exaggerated negative core beliefs about oneself, others, or the world, such as “What happened was my fault because I am a bad person,” “No one should be trusted,” “The world is not a safe place,” “I am fundamentally broken and flawed,” etc.
- Distorted thoughts about the root cause of the traumatic event, often leading the person to inappropriately blame themselves or others for the event occurring
- Ongoing negative emotional state, typically characterized by feelings of fear, horror, anger, guilt, and shame
- Diminished interest and participation in activities that once brought joy or used to be significant components of a person’s life
- A sensation of detachment from other people and society as a whole
- Anhedonia, or the inability to experience happiness and other positive emotions
Two or more arousal and reactivity symptoms:
- Irritability and angry outbursts with no apparent provocation, which may manifest as verbal or physical aggression toward other people
- Reckless or self-destructive behavior, including substance misuse (in the past, substance misuse was often described as “substance abuse,” and this language may still be referenced in older scientific articles and research about PTSD)
- Hypervigilance
- Extreme or exaggerated startle response
- Difficulty concentrating
- Sleep disturbances, including experiencing restless sleep and/or having difficulty falling or staying asleep
Additional symptoms that are not necessary for diagnosis but can be common in people who develop PTSD include experiences of dissociation. Dissociation typically involves depersonalization, in which a person senses they are separate from their body and watching themselves from afar, or derealization, in which a person senses that the world around them is altered or strange, such as having the impression that they are viewing their surroundings through blurred glass or water.
Symptoms typically need to last for more than one month and cause distress or significant impairment in functioning for a person to receive a PTSD diagnosis. For many people, it can be typical for symptoms to emerge shortly after experiencing the traumatic event, but there is no set timeline for developing PTSD. Some people may not demonstrate any symptoms for months or even years. In these cases, a specifier of “delayed onset” may be added to a PTSD diagnosis.
Who can diagnose PTSD?
Post-traumatic stress disorder is typically diagnosed through a psychological evaluation and screening process. Several different assessments can be used to check for the presence of both traumatic experiences and PTSD symptoms. While some of these assessments are publicly available for individuals to take on their own, only a licensed mental health professional can provide an official diagnosis. It is almost always more effective to receive a diagnosis from a mental health professional so that you can collaborate on a plan to determine the next steps in PTSD treatment.
- Licensed clinical social workers (LCSWs)
- Licensed professional mental health counselors (LPMHCs)
- Licensed marriage and family therapists (LMFTs)
- Psychiatrists and psychiatric nurse practitioners – It tends to be unusual for these providers to diagnose PTSD, as they are more likely to be brought into a PTSD treatment plan if medications are needed, but they can still make a diagnosis if necessary
- Psychologists and neuropsychologists – Again, it would be unusual for these providers to diagnose PTSD, as they tend to focus more on conducting PTSD research than on working directly with people with PTSD
Treatments for PTSD
PTSD is treatable, and many people who undergo PTSD treatment demonstrate marked improvements in their symptoms. One of the most effective forms of PTSD treatment is called talk therapy, specifically cognitive behavioral therapy (CBT).
With CBT, a person generally meets regularly with a therapist to focus on understanding the relationship between their thoughts and their behaviors. PTSD-focused cognitive behavioral therapy typically focuses on restructuring the negative and distorted beliefs that can be foundational to the disorder. Other therapeutic techniques, such as exposure therapy and eye movement desensitization and reprocessing (EMDR) therapy, may also be helpful.
Some PTSD symptoms, like hypervigilance and flashbacks, can make the thought of leaving the house to attend a traditional in-person therapy appointment seem overwhelming. If this is the case for you, online therapy could be a beneficial alternative. With online therapy through an accredited platform like BetterHelp, you can talk to your therapist from the safe space and comfort of your own home via video conference, phone call, or online chat.
Studies have shown that treatments for PTSD may be just as effective when delivered in an online format as in traditional in-person therapy settings. A 2022 study showed that online therapy for PTSD can produce the same client outcomes as in-office therapy. If you would like to take charge of your traumatic memories and move forward with your life, online therapy could be a helpful resource.
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