PTSD Symptoms: DSM Criteria for Diagnosis

By Abigail Boyd|Updated June 30, 2022
CheckedMedically Reviewed By Dawn Brown, LPC

It's normal to feel fear, shock, and anxiety during or after a traumatic experience, especially one that occurred without warning. Traumatic experiences activate the body's natural stress response, priming us to fight or flee in the face of danger. The brains of some people, however, interpret stress in a way that causes them to freeze and dissociate from the present moment. This is the brain's way of protecting itself from harm in the face of unmanageable fear and anxiety.

Can a therapist diagnose PTSD? Yes, seeking help from an online therapist and psychiatrist can be really effective treatment options and help you diagnose PTSD. Diagnosing post-traumatic stress disorder involves following a PTSD symptom checklist in the DSM-5. The DSM is the Diagnostic and Statistical Manual of Mental Disorders, of which the fifth edition is the latest. This manual is the official source of outlining mental and mood disorders. Additionally, taking a PTSD test with a therapist can help reach a diagnosis. 

What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a condition that can occur due to experiencing or bearing witness to a traumatic event or series of events in which a person feels helpless, trapped, or scared for their life or the lives of their loved ones. While veterans are often diagnosed with PTSD, many different people who have experienced traumatic events will end up developing the condition.

While a diagnosis from a professional is always required, consulting a PTSD symptoms checklist can help you determine if you should seek a consultation. PTSD symptoms can significantly impact your ability to live a normal life and can develop into a chronic condition over time if left unchecked.

PTSD DSM 5 Criteria

To be diagnosed with PTSD, there is a list of criteria that needs to be met. While PTSD can manifest differently between individuals, there are guidelines that outline the condition. These are found in the current edition of the DSM.

First, there needs to be a specific trigger that acted as the source of the trauma. This may be active combat, the sudden death of a loved one, a near-death experience, domestic abuse, a car accident, or another trigger. Symptoms must begin after the event, usually between one to three months, but possibly up to years afterward.

The symptoms must cause significant interference in the person's ability to function in one or more areas. This may include your work, relationships, and other areas. In addition, other primary causes, such as mood disorders or substance abuse, must be ruled out.

PTSD Symptoms - DSM 5

PTSD symptoms fall under four separate categories. The patient should have at least one symptom from each category to qualify for diagnosis. Depending on the individual and the severity of their condition, each cluster of symptoms may range from mild to severe. These can fluctuate over time, becoming more apparent and then receding only to return again later. Some individuals, particularly those with a strong social support system and no history of depression or anxiety, may recover spontaneously from PTSD within a few months to a year.

For many others, however, PTSD symptoms can become chronic. Unfortunately, these people may avoid seeking treatment because of difficulty they experience when confronting their uncomfortable emotions and feelings. However, this only leads to the condition becoming more deeply rooted.

The four separate categories outlined in the DSM-5 for PTSD are:

Dissociation

After the traumatic event, intrusive symptoms related to the trauma may begin to arise. In turn, the brain may begin to dissociate in an attempt to cope. Dissociation can be set off temporarily by specific, identifiable triggers, or may be ongoing and chronic. Depending on the severity of these symptoms, you may feel as though you're reliving the trauma. These symptoms may cause extreme emotional distress or, conversely, you may feel numb and detached, like you're watching your life through a movie screen.

Symptoms may include:

  • Intrusive memories of the trauma
  • Flashbacks
  • Vivid nightmares or night terrors
  • Depersonalization
  • Feelings of unreality
  • Brain fog

Hyperarousal

Changes to the brain that occur due to trauma can increase vigilance and cause it to misinterpret situations as unsafe. Your brain is constantly scanning for signs of danger and can overreact to benign triggers that it interprets as threatening. This can lead to a constant state of anxiety in which the body's fight-or-flight response is frequently misfiring.

Symptoms may include:

  • Restlessness
  • Irritability
  • Exaggerated startle response
  • Difficulty falling or staying asleep
  • Panic attacks
  • Worry
  • Social anxiety

Avoidance

Many people with PTSD refuse to speak about the traumatic event or its ongoing effect on their mental health. You may avoid places that trigger emotions or memories related to the trauma. This may be an actual location where the trauma took place, people who were present at the time, or more extensive triggers. For example, you may avoid driving or riding in a car after a car accident. However, this avoidance only creates a stronger association between the brain's fear center and the triggers.

Symptoms may include:

  • Refusing to return to the site of the trauma
  • Avoidance of any triggers associated with the trauma
  • Changes to routine to avoid triggers
  • Refusal to speak about the event
  • Conscious or subconscious thought suppression
  • Isolation

Negative Thinking & Mood Changes

PTSD contributes to changes in thinking, cognitive processing, and mood. Depression and anxiety are commonly associated with PTSD. Areas of the brain involved in memory, particularly short-term memory, may be impacted. Even if the person with PTSD was not directly involved in causing the trauma, there may be a loss of self-esteem and persistent feelings of guilt, shame, and blame.

  • Emotional numbness
  • Short-term memory problems
  • Lack of memory related to the trauma
  • Low self-confidence
  • Self-blame
  • Rumination
  • Sleep disturbances

What Causes PTSD Symptoms?

As previously stated, many situations can be a trigger for PTSD. While commonly associated with veterans of war, PTSD has been known to have many causes, including being the victim of a crime, experiencing the death of a loved one, sexual assault, bullying, and domestic abuse. The common denominator is the experience of extreme fear and helplessness that causes the brain to get stuck in protective mode.

Not everyone who witnesses or experiences a terrifying event or series of events will develop symptoms of PTSD. Some people will experience mild symptoms of fear and emotional upset for a while after a traumatic event, but eventually, get better with time and social support.

Parts of the Brain Involved in PTSD

Brain scans have shown what many scientists suspected for many years: the brains of those afflicted with posttraumatic stress disorder symptoms operate differently than those without the condition. A few regions involved in PTSD have been identified using functional MRI (fMRI) scans and other forms of brain imaging technology.

The amygdala, a small area of the limbic system which is responsible for processing emotions, is involved in our perception of fear. Brain scans of people with PTSD show abnormally high activity in the amygdala in relation to triggering stimulus. The hippocampus, another area which is involved in memory processing, also shows high reactivity.

These areas and others in the brain become conditioned to interpret environmental cues that the brain has connected to the past trauma. Triggers can be anything even loosely associated with the event, such as a song, a scent, a name, or a place. You may not be aware of all of your potential triggers until they set off your symptoms.

How is PTSD Treated?

There are many effective treatments available for PTSD. While recovery takes commitment, time, and the effort to process feelings and thoughts related to the trauma, success rates are extremely promising.

Types of treatment that have shown success in treating PTSD include:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a type of talk therapy focused on recognizing and changing negative thinking patterns and associated behaviors. Since this type of therapy has been around for decades, it has the most research behind it in regards to treating conditions such as depression, anxiety, and PTSD.

You may have mixed feelings about seeking help, but know that you're not alone. Online therapy from a professional counselor, such as that offered by BetterHelp, can allow you to access therapy from the comfort of your home.

Behavioral Activation

Behavioral activation is one type of CBT. Conditions such as PTSD and depression often cause a person to lose motivation and isolate themselves. This can make it hard to take the steps necessary to get better. Instead of trying to examine thoughts directly, behavioral activation focuses on acting first. The goal is to slowly shift how we feel and think by repeating positive behaviors. If you're struggling with waiting to feel a certain way before acting, behavioral activation can teach you strategies for defeating these avoidance behaviors.

Eye Movement Desensitization And Reprocessing (EMDR)

EMDR is an innovative type of psychiatric treatment that involves directing eye movements in a way that is thought to help the brain with processing memories of the traumatic experience. Once a controversial treatment, EMDR is gaining widespread acceptance as studies have begun to show its efficacy in treating the condition.

Other treatments are available for PTSD, including certain medications. It's important to work with a healthcare professional that has experience with the condition in order to receive the treatment that will work for you specifically. Try to go into the treatment process with an open mind and a positive outlook. While it can be difficult to face the pain of trauma, doing so can free you to regain control of your life.

PTSD symptoms DSM 5

Sources:

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

https://www.psychologytoday.com/us/blog/mouse-man/200901/the-anatomy-posttraumatic-stress-disorder

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