Post-Traumatic Stress Disorder: DSM 5 Criteria

Medically reviewed by April Justice, LICSW
Updated March 21, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

Like other mental health conditions, post-traumatic stress disorder (PTSD) may sometimes be misunderstood. The public may not always know the diagnostic criteria for PTSD, which can lead to mislabeling and misdiagnoses of this mental illness. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is the most current version of the diagnostic tool used by licensed mental health practitioners. Therefore, examining the DSM-5 may help you better understand PTSD and PTSD symptoms.

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Living with PTSD can be challenging

What is PTSD?

While the Diagnostic and Statistical Manual of Mental Disorders sets forth specific criteria for diagnosing PTSD, this information may feel too complex if you're unsure what to look for. Often, mental health professionals may use everyday language to talk about PTSD so that it is easier to understand. 

One of the main diagnostic criteria of PTSD is that its symptoms are caused by a traumatic event or multiple traumatic occurrences. Although PTSD is perhaps best known as a result of direct trauma, indirect exposure to a traumatic or stressful event can also be a cause. Those who develop PTSD may experience an event themselves, witness it happen to others, learn that an event occurred to a loved one, or experience repeated and extreme details of an event. 

Traumatic events may include, but are not limited to: 

  • War or military service 
  • Natural disasters 
  • Intimate partner violence or domestic violence
  • Threatened death or serious injury
  • Threatened sexual violence
  • Emotional abuse
  • Sexual abuse 
  • Prolonged childhood abuse
  • Accidents
  • Traumatic death or loss of a loved one

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

The PTSD DSM 5 criteria specify that symptoms must be present for a month or more in order to receive a PTSD diagnosis. If symptoms are present for less than a month, a person may instead be experiencing one of several other stressor related disorders, such as acute stress disorder (ASD), which is similar to PTSD but has a shorter duration.  

PTSD may cause emotional distress, although the specific symptoms can vary between individuals. Possible symptoms include feelings of detachment, a loss of participation in previously enjoyed activities, angry outbursts, and other dissociative symptoms. In the aftermath of trauma, negative affect and other negative alterations in mood may also be present.

Along with these symptoms, those experiencing PTSD may experience frequent unwelcome intrusions or vivid memories of the traumatic event. They may avoid trauma related stimuli or other situations that may bring negative feelings associated with their trauma. Additionally, those experiencing PTSD may also experience other mental health challenges, such as depression or anxiety disorder. 

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What is the DSM-5?

The DSM stands for Diagnostic and Statistical Manual of Mental Disorders, and it serves as a diagnostic tool for psychological disorders. The book was initially published in 1952 and has been updated multiple times, resulting in the current edition of the DSM-5.

The DSM was created by over 160 clinicians and researchers from across the globe. According to the American Psychiatric Association (APA), the creator of the DSM, "We anticipate the APA has spent $20-25 million on this extensive process. All of these funds came from APA's reserves, and the association received no commercial or government funding for the development of DSM-5."

The APA is a non-profit organization representing psychiatrists, and sees the DSM-5 as "an investment in the future of mental health allowing for more precise identification of mental disorders as well as facilitating new research."

The DSM includes symptoms and criteria professionals can use to diagnose patients with mental health conditions. This guidebook may also help make diagnosing and communicating about mental illness more consistent as professionals worldwide turn to it for information and guidance.

Changes in the DSM-5: PTSD

The most recent update to the DSM brought some significant changes regarding PTSD from what it used to be. PTSD used to be included under anxiety disorders, but it has since been moved to a new chapter on trauma and stress-related disorders.

One of the other changes was to the diagnostic criteria for PTSD. The full diagnostic criteria now includes four symptom groups, instead of the previous three, and lists 20 symptoms rather than 17.

PTSD criteria

To be diagnosed with PTSD, individuals may meet numerous criteria outlined in the DSM-5. To receive a diagnosis of PTSD, a person must have at least one re-experiencing symptom, three avoidance symptoms, two negative alterations in mood and cognition, and two hyperarousal symptoms. 

Criterion A: Exposure

For a PTSD diagnosis, an individual must have been exposed to a traumatic event. This exposure can include directly experiencing the event, witnessing the event, learning the event has occurred to a loved one, or repeatedly dealing with aversive details of an event.

The trauma may be multiple or singular events, including war, car accidents, natural disasters, sexual assault, or abandonment, among other causes. 

An individual with PTSD may not have directly experienced this event. For example, a doctor treating traumatized patients may develop PTSD from witnessing trauma's physical and emotional impact. Someone who works as a nurse for active-duty combat colleagues may treat traumatic injuries and develop PTSD. There are several situations where this may occur. 

Criterion B: Intrusion

One of the diagnostic criteria of PTSD is intrusion. Intrusion may mean re-experiencing an event or having vivid and distressing memories. It could include the following: 

  • Distressing dreams or nightmares 
  • Flashbacks (feeling that you are genuinely experiencing the trauma again)
  • Uncomfortable and vivid memories of the trauma 
  • Prolonged psychological distress after trauma-related stimuli (internal or external cues that remind the individual of the traumatic event)
  • Physiological reactions after internal or external cues

Criterion C: Avoidance of traumatic reminders

Someone diagnosed with PTSD may also be exhibiting avoidance behaviors. The person may avoid distressing memories, intrusive thoughts, or negative emotions that remind them of the event. 

They may also avoid physical reminders of the traumatic event. For example, they may decline to spend time with friends at a bar because their trauma occurred at a bar. 

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Living with PTSD can be challenging

Criterion D: Physical reactivity

Criterion D claims that an individual may exhibit at least two of the following negative changes in mood or cognition.

  • Difficulty remembering details about the event
  • Persistent, negative beliefs about themselves, others, or the world as a whole
  • Blaming oneself for the event's occurrence
  • Persistent "negative emotional state," for example, feeling sad, angry, or fearful
  • Decreased interest in previously enjoyed activities
  • Feeling detached from others
  • Inability to experience positive emotions

Criterion E: Changes in arousal and reactivity

PTSD diagnoses may require a significant change in arousal and reactivity. This change in arousal and reactivity must have arisen or worsened after the traumatic event and may include at least two symptoms from the following list: 

  • Increased irritability and aggression, either verbal or physical
  • Hypervigilance
  • Participating in risky or self-destructive behavior
  • Difficulty concentrating
  • Problems sleeping
  • Increased startle response

Other criteria

There are a few other pieces of criteria that may be present for someone to be diagnosed with PTSD: 

  • The symptoms occur for at least one month
  • Symptoms impact or cause clinically significant distress in everyday life, such as socially or at work
  • The symptoms cannot be attributed to the effects of a substance or other mental health condition 

PTSD treatment

The first step to managing PTSD is receiving an accurate diagnosis. After this occurs, individuals may begin working on managing their PTSD symptoms with their behavioral health services provider. 

Several forms of therapy have been proven effective in treating PTSD, including the following: 

  • Internal family systems therapy (IFS) 
  • Eye movement desensitization and reprocessing (EMDR)
  • Somatic Experiencing and equine therapy
  • Art therapy

Those who are experiencing mental health conditions in addition to PTSD may also benefit from other forms of treatment, such as substance abuse treatment. If you or a loved one is experiencing challenges with substance use, you may contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at (800) 662-4357.

Living with PTSD can be a challenging experience, but treatment is possible through the right mental health services. If you've been diagnosed with PTSD, you may benefit from working with a licensed therapist as you accept your diagnosis and learn how to manage your symptoms.

Since PTSD may include a variety of symptoms, individuals living with this mental health condition may have difficulty leaving home, committing to traveling, or directly interacting with strangers. Online therapy can remove some of the fear that people with PTSD may have about meeting with a new therapist.

Research suggests that EMDR therapy is an effective and safe option for PTSD patients. In modern society, EMDR is available online as well as in person. If you are considering trying CBT, EMDR, or another form of online trauma therapy, online platforms such as BetterHelp are available. These platforms offer a vast database of therapists specializing in various areas, including trauma-related disorders.

Takeaway

The DSM-5 sets forth the current criteria for diagnosing PTSD. Once an individual is diagnosed with PTSD, they may seek treatment for their symptoms. If you're ready to seek support, consider contacting a mental health counselor.

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