How A Professional Comes To A PTSD Diagnosis
Updated August 28, 2020
Medically Reviewed By: Melinda Santa
According to PTSD United, roughly 24.4 million Americans have PTSD. Despite its prevalence, the condition is still somewhat misunderstood, and many people try to cope with their symptoms alone. Seeking a diagnosis for PTSD is important for many reasons including getting much-needed treatment. Mental health professionals have a few key resources they can use to help a patient get their answer. If you suspect that you or a loved one are dealing with PTSD, but aren't quite sure, consider what we know about the disorder so far and how a trip to your provider can clear up your questions.
What Is PTSD?
PTSD, formally known as Posttraumatic Stress Disorder, is a trauma related disorder that presents a number of serious symptoms. Symptoms can include:
- Intrusive memories about an experience
- Distressing dreams or nightmares about an experience
- Reluctance to talk about an event
- Avoiding things or places associated with an event
- Difficulty remembering details associated with an event
- Negative beliefs
- Heightened emotional state
- Lack of interest in activities
- Feeling detached
- Difficulty experiencing positive emotions
- Difficulty concentrating
- Sleep disturbances
Most people believe the disorder only affects those who see or experience a traumatic event first-hand, however, just hearing about traumatic events that happen to those we love may trigger symptoms as well. Another common misconception is that trauma only happens suddenly or in a single event. Unfortunately, repeated exposure to trauma over time can lead to the disorder as well. We often see this with first responders and police officers.
Traumatic events are hard to define. Everyone has their own interpretation of their triggers and unique tolerance to stressful events. However, traumatic events can include (but are not limited to):
- Separation from loved ones
- Serious accidents
- Medical procedures/illness
- Domestic violence
- Natural disasters
How Do Clinicians Diagnose PTSD?
The process of diagnosing PTSD is fairly straightforward. A number of medical professionals, collectively called clinicians, can determine if someone meets the criteria. Primary care doctors, psychiatrists or clinical mental health counselors are usually those to identify the condition. Diagnosis usually happens in one of two ways. Either a person suspects they have PTSD and seeks confirmation from a professional or changes in their mental health and personality leave them searching for an answer as to what may be going on.
Most health conditions are discovered through "biological markers." Biological markers are the things we look for in or on the body to confirm disease. For example, if a doctor suspects their patient is suffering from a certain type of blood cancer, they can perform blood testing and bone marrow biopsies to confirm their suspicions. Unfortunately, PTSD does not have any biological markers. A diagnosis can only be made based on a person's self-reported symptoms and their clinician's ability to rule out other possible mental health conditions.
Clinicians typically use two tools to help them decide if a PTSD diagnosis is right for their patient. The first is called the Diagnostic and Statistical Manual of Mental Disorders, referred to simply as the DSM. The second is a series of screenings that the patient may complete to describe the type and severity of their symptoms. These screenings differ from practice to practice. They usually not only look for symptoms of PTSD but of anxiety, depression, bipolar disorder and other mental health conditions as well.
Based on the results of a patient's screening and how well their symptoms fit into the DSM's criteria, a PTSD diagnosis can be made. In most cases, it only takes one visit with a provider to confirm or rule out the disorder. Although the process is direct, there are some things patients should know. Diagnosing mental health disorders is not as easy as it seems.
The Role Of The DSM
The most current version of the DSM is called the DSM-5®. Almost all clinicians consider it to be the top authority when it comes to assessing mental health. The DSM-5® is broken down by types of disorders. For example, all disorders that are considered depressive disorders are grouped together. All disorders that are anxiety disorders are grouped together. The DSM-5® classifies PTSD as a "Trauma-and Stressor-Related Disorder." It appears in this category with other mental health conditions such as Reactive Attachment Disorder, Acute Stress Disorder and Adjustment Disorder. These conditions occur as a result of exposure to trauma or stress.
One of the most important jobs of the clinician is to use the DSM-5® to determine the right category of mental health disorder their patient is experiencing, and then within that category, the correct diagnosis. They must gather enough information from their patient to fit one of the conditions the DSM-5® describes. In the event, their patient reports symptoms that overlap with other conditions (such as PTSD and Generalized Anxiety Disorder or Major Depressive Disorder), they must plan treatment carefully to address both concerns.
DSM-5® And PTSD
There are specific requirements a patient must meet before they can get a PTSD diagnosis, according to the DSM-5®. The first factor a clinician should assess is the age of their patient. The DSM-5® presents different criteria for patients over the age of six and under the age of six. If their patient is over the age of six, the following applies.
First, the patient must have been exposed to or experienced a perceived threat to death, serious injury or sexual violence. This can occur through direct experience, witnessing the event, learning about the event or being exposed to the event repeatedly. PTSD is not typically diagnosed if someone only witnessed the event via pictures, television or movies unless the exposure was a part of their work (such as a police officer seeing pictures of a devastating crime scene).
Second, the patient must experience one or more "intrusion symptoms" following the event. Intrusion symptoms are those that take the patient back to the original event and come on unexpectedly. These can include things like flashbacks, dreams, intrusive thoughts or memories. The patient must also experience "avoidance" of the trauma event. This means they try not to think about or go to places associated with it. They limit their exposure to anything that reminds them of the event.
Third, clinicians evaluate their patients for any negative or depressed thoughts or moods following the event. These behaviors will have surfaced or gotten worse following their exposure to the trauma. Likewise, they look for any increase or agitation in the emotional state. A PTSD diagnosis usually requires at least two examples of each of these changes in a patient's day-to-day life.
The clinician will also take into account how long someone has dealt with his or her symptoms. The DSM-5® considers a diagnosis of PTSD to be valid if a patient reports they have experienced their symptoms for at least 1 month or longer. However, there are exceptions, as some patient's may not meet the full criteria for diagnosis until 6 months or more after the event. If the symptoms listed above are present but have not occurred for at least 1 month, the patient may qualify for a diagnosis other than PTSD. Correct diagnosis is vital to provide the best treatment.
Why Diagnosis Is Important
There are a few reasons why diagnosis is important with any mental health condition. The first is that diagnosis gives medical professionals an idea of how to treat their patients. Treatment methods vary by the disorder. If someone is experiencing PTSD, it is unlikely treatment methods used for depression or bipolar disorder will help them reach full management of their symptoms.
Diagnosis also streamlines communications between medical professionals. If a patient arrives in the ER meeting the criteria for PTSD and is referred to a psychiatrist, the psychiatrist immediately knows what to expect when working with the patient. Although every patient will experience conditions like PTSD in their own way, a general understanding of the disorder gives a medical team a lot of information to start with.
In the United States, diagnosis is key if you use health insurance to pay medical bills. Insurance companies do not pay unless they know what they are paying for. Each diagnosis in the DSM-5® corresponds to a number called an ICD-9-CM or ICD-10-CM code. Insurance companies look at this code to decide whether to help cover medical treatments.
Lastly, a diagnosis brings with it resources for patients. Before someone is formally diagnosed with PTSD there is often little help for him or her. However, once they have the diagnosis, they can be referred to specialist medical professionals, obtain medications, seek the help of a counselor, join support groups, and more. Diagnosis is often the first step toward feeling better.
PTSD is a frightening mental health condition. Professionals rely on what their patients tell them and tools like mental health screenings and the DSM-5® to get those suffering from PTSD the help they need. If you suspect you are experiencing PTSD, reach out to BetterHelp.com. Whether you are seeking a diagnosis or symptom management, we can help you.