Post-Traumatic Stress Disorder: DSM 5 Criteria

By Stephanie Kirby|Updated August 3, 2022

Are You Ready To Put A Diagnosis To Your Mental Health Struggles?

Mental health illness and mental health disorders can be a very difficult thing for people to understand. Each disorder can come with a wide range of symptoms and each person can experience it at a different level of severity. PTSD is no different. This can make it difficult to diagnose and treat. That's why there is a need for PTSD DSM 5 criteria.

What is PTSD?

Before diving into the DSM criteria for PTSD, here are the basics of what PTSD is.

PTSD stands for post-traumatic stress disorder. It is commonly associated with veterans. However, as you will learn in the remainder of this article, PTSD can be diagnosed in anyone that meets the criteria. It is not just a mental health disorder for those in the military. There are a wide range of traumatic events that can occur that can lead to PTSD. However, because of the traumatic events that many veterans experience, such as war-zones and being injured in combat, they have a higher risk of developing PTSD.

PTSD symptoms create distress in the individual, including anxiety, irritable behavior, hypervigilance, and aversion to triggers related to the traumatic event. And while typically PTSD applies to the person who experienced the trauma, indirect exposure to the traumatic event can cause PTSD as well.

What is the DSM-5?

Used to diagnose mental disorders, DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It's a book that is basically like an encyclopedia of psychological disorders. The book originally was published in 1952, but has been updated multiple times resulting in the current edition of the DSM-5.

The DSM was created by over a hundred and sixty clinicians and researchers from all over the globe. The purpose of creating the DSM is to provide a handbook for mental health professionals and other healthcare workers.

The DSM includes lists of symptoms and criteria that they can use in order to diagnose patients with mental disorders. This guidebook helps to make diagnosis and communication about mental illness more consistent.

Over the years, the book has continued to be updated and revised as there is research consistently happening on an ongoing basis around mental health disorders. These revisions help to keep the book accurate for our current day in order to help the most amounts of people. The most recent additions to the book were made in order to include symptoms that people were commonly experiencing with mental disorders such as PTSD, but we're not already included in the book.

Are You Ready To Put A Diagnosis To Your Mental Health Struggles?

Because mental health professionals are using this book in order to diagnose patients, a lack of the right symptoms being included could cause people not to be diagnosed. This would mean that they would not have access to the treatment that they would need in order to gain control of their mental health challenges.

This book is not something that is taken lightly in the world of healthcare and mental health. It is a collaboration of many professionals and is used around 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. APA is a non-profit organization representing psychiatrists and sees 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."

Changes in DSM-5: PTSD

As you can see, there were important changes made to the DSM-5 regarding mental health disorders in order to help treat patients more effectively. One of the changes made in the most recent edition was moving PTSD from the section on Anxiety Disorders to a new chapter on Trauma- and Stress- or- Related Disorders.

One of the other major changes that the revised version made is removing "sudden death of a loved one" from the criteria. Overall, it is not believed that the changes made to the PTSD criteria will have a large impact on diagnosis of this disorder.

One change that was not made in the DSM-5, but that some people are pushing for is renaming PTSD from Post-traumatic Stress Disorder to Post-Traumatic Stress Injury. There are retired and active-duty military leaders that are pushing for this change. They believe that by dropping the word "disorder" and replacing it with "injury" could cause more veterans and soldiers to seek help for the symptoms that they are experiencing. However, at this time, the name has remained the same.

PTSD Criteria

In order to be diagnosed with PTSD, you will have had to be exposed to a stressful or traumatic event. And, the DSM has established criteria to show what counts as a traumatic event. They can be loosely categorized as exposure, intrusion, traumatic reminders, physical reactivity, and lack of positive affect. In order for a diagnosis to be made, each diagnostic criterion has to be met:

Exposure/Criterion A (at least one symptom)

In order for a PTSD diagnosis to be made, the person has to have direct exposure—witnessing, experiencing, or experiencing other exposure to death. This doesn't mean that they had to be near death. It means that there needs to have been actual or threatened death or serious injury. This section also includes sexual violence.

It's also important to establish that the person doesn't have to be the one that was in danger. While it could be that they were exposed directly, it could also be witnessing the traumatic event, finding out about a relative or close friend who was exposed to threatened death or serious injury, or experiencing repeated or extreme exposure indirectly, such as through aversive details. Aversive details can be trauma-related images, experiences, or other stimuli (e.g., first responders collecting human remains, a detective repeated exposed to actual or threatened sexual violence).

Intrusion/Criterion B (at least one symptom)

Before someone can be diagnosed, they need to be re-experiencing the event on an on-going basis. This doesn't mean that they need to be living through the same thing over and over again, but experiencing it through one of the following:

  • Recurrent distressing dreams
  • Flashbacks
  • Distressing memories
  • 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 

Avoidance Of Traumatic Reminders/Criterion C (at least one symptom)

The person is showing avoidance behaviors. This means that they are trying to avoid reminders of the traumatic event. Criterion C can apply to distressing memories, intrusive thoughts, or negative emotions. This can be through physical reminders, the distressing memories themselves, or other things that make them think about the traumatic event.

Physical Reactivity/Criterion D (at least two symptoms)

The person experiences negative alterations in understanding and emotions. These negative alterations can include feeling distress about the traumatic event, overly negative thoughts about the world, having a persistent negative emotional state, not caring about activities they used to enjoy, isolation, and difficulty recalling details of the event. This also includes exaggerated negative beliefs, like blaming themselves or someone else for the traumatic event.

Lack of Positive Affect/Criterion E (at least two symptoms)

PTSD diagnosis requires a significant change in arousal and reactivity. This change in arousal and reactivity must have arisen or worsened after the traumatic event and must consist of at least two of the following symptoms:

  • Increased aggression, whether verbal or physical aggression, or irritable behavior (following little or no provocation), often in the form of angry outbursts
  • Hypervigilance (similar to paranoia)
  • Participating in risky behavior
  • Hard time concentrating
  • Problems sleeping
  • Increased startle response

Other Criteria

There are a few other pieces of criteria that must be present in order for someone to be diagnosed with PTSD. They include:

  • Experience symptoms for at least one month
  • Symptoms impact impairment or clinically significant distress in normal life such as socially or at work

Subtypes

There are two subtypes that have been specified for PTSD. They include Preschool Subtype and PTSD Dissociated Subtype.

The preschool subtype is for children that are under the age of six years old. The Dissociate Subtype is for people that also experience feelings of being detached from their own body or having experiences that make it seem as though the world were not real.

PTSD Treatment

PTSD is a treatable mental health diagnosis. Those that are suffering have several different forms of treatment that they can choose from. Many people, similar to other mental health disorders, find that they experience the best results when they use a combination of treatment.

Some of the most commonly used forms of treatment include:

Therapy

There are several forms of therapy that are effective at treating PTSD. Two of the most commonly used include CBT and Exposure Therapy.

CBT stands for Cognitive Behavioral Therapy. This type of therapy focuses on teaching people how to control their response and behaviors. Since those with PTSD aren't going to be able to control every time they are exposed to or reminded of the traumatic event, instead they are taught healthy strategies that they can use to respond.

Exposure Therapy works by exposing people with PTSD to the thing that caused their trauma. This is carefully down with a therapist to make sure that people are exposing themselves in the proper way and at the right time and level. They start small and work their way up the ladder as their symptoms lessen with exposure to the trigger.

Medication

Medications such as antidepressants and antipsychotic medications can be effective for people with symptoms from PTSD. The right type of medication will be based on the symptoms that a person is experiencing as well as their specific situation. As with any type of medication for mental health, the first prescription is not always the one that works.

If you have been placed on a medication and find that it's not working after giving it time, contact your doctor and ask about a different form of medication.

Medication does not need to be used as an ongoing form of treatment, but it can be helpful to use while you use other forms of treatment to learn how to get symptoms under control. It is important that you take medication exactly as prescribed by your doctor or psychiatrist.

There are other forms of treatment and mental health services that can be helpful for treating PTSD. In order to find the best options for you, reach out to an experienced therapist. For PTSD some forms of treatment make it necessary to be in person with a therapist. However, supplemental online therapy can also be a helpful part of treatment plans. It makes it easier and faster for you to get in touch with your therapist when you are struggling.

The most important thing is that you get the help that you need. Don't stop until you are able to see improvement in your symptoms.

You Don't Have To Face Post Traumatic Stress Disorder Alone.
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