PTSD Symptoms: DSM-5 Criteria For Diagnosis

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated June 20, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Explore PTSD and the DSM-5 criteria for diagnosis

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a mental illness outlined in the DSM-5 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 many people associate PTSD with war veterans, many people who have experienced traumatic events develop the condition. PTSD is most commonly diagnosed in women who have experienced abuse or assault.  

While it doesn’t replace the advice of a mental health professional, consulting a PTSD symptoms checklist may help you determine whether seeking support would be beneficial for you. PTSD symptoms can significantly impact your ability to function each day and can develop into a chronic condition over time.

PTSD DSM-5 criteria

To be diagnosed with PTSD, there is a list of criteria that mental health professionals look for. While PTSD can manifest differently between individuals, the guidelines in the DSM-5 outline the common symptoms of the condition. 

For example, a PTSD diagnosis can be made only when an individual has experienced or witnessed a trauma. The trauma could be active combat, the sudden death of a loved one, a near-death experience, domestic abuse, a car accident, or another event. Symptoms often begin a few months to years after the event. 

For a diagnosis, the professional may look at whether the symptoms cause significant interference in the person's ability to function in one or more areas. These areas may include work, school, relationships, and daily responsibilities. In addition, other potential causes of symptoms like mood disorders or substance use disorders may be ruled out.

PTSD symptoms in the DSM-5

PTSD symptoms fall under four separate categories. Professionals look at whether the client has 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 later. Some individuals with a strong social support system and no history of depression or anxiety may recover from PTSD within a few months to a year. 

For many others, however, PTSD symptoms can become chronic. These individuals may avoid seeking treatment because of the difficulty they experience when confronting their uncomfortable emotions and feelings. However, this can lead the condition to become more deeply rooted. The four separate categories outlined in the DSM-5 for PTSD are as follows:

Dissociation

After a traumatic event, intrusive symptoms related to the traumatic event may arise. In turn, the brain may begin to dissociate to cope. Dissociation may be set off temporarily by specific, identifiable triggers, or it 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 emotional distress, or, conversely, you may feel numb and detached.

Symptoms could include: 

  • Intrusive memories of the trauma
  • Flashbacks
  • Vivid nightmares or night terrors
  • Depersonalization (the feeling that you or others are not real or present) 
  • Feelings of being detached from reality 
  • Brain fog
Getty/AnnaStills

Hyperarousal

Changes to the brain that occur due to trauma can increase vigilance and cause the brain to misinterpret safe situations as unsafe. The brain may scan for signs of danger and identify triggers that it interprets as threatening due to associations with the traumatic event you went through. This process might lead to anxiety in which the body's fight-or-flight response is consistently activated. 

Symptoms may include:

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

Avoidance

Some people with PTSD may refuse to speak about the traumatic event or its ongoing effect on their mental health. If you are experiencing avoidance symptoms, you may avoid places or people that incite emotions or memories related to the event. For example, you might avoid the actual location where the trauma took place, people who were present at the time, or stimuli that reminds you of it. For example, you may avoid driving or riding in a car after a car accident. However, this avoidance may create a stronger association between the brain's fear center and the triggers.

Symptoms may include:

  • Refusal 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 and mood changes

PTSD can lead to changes in thinking, cognitive processing, and mood. Depression and anxiety are commonly associated with PTSD for this reason. Areas of the brain involved in memory may also be impacted. Even if the person with PTSD was not directly involved in the trauma, there may be a loss of self-esteem and persistent feelings of guilt, shame, or blame. 

Symptoms related to negative thinking and cognitive processing may include:

  • 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?

Many situations can cause PTSD symptoms to occur. While commonly associated with war, PTSD has been known to have many causes, including crime, experiencing the death of a loved one, sexual assault, bullying, and domestic abuse. The common denominator may be the experience of fear and helplessness. 

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

Parts of the brain involved in PTSD

Brain scans have shown that the brains of those with PTSD symptoms operate differently. A few regions involved in PTSD have been identified using functional MRI (fMRI) scans and other forms of brain imaging technology.

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

These areas and others in the brain can 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 your potential triggers until they set off your symptoms.

How is PTSD treated?

Many effective treatments are available for PTSD, and success rates may be promising. The types of treatment that have shown success in treating PTSD include the following. 

Cognitive-behavioral therapy (CBT) 

Cognitive-behavioral therapy (CBT) is a type of talk therapy focused on recognizing and changing unwanted thinking patterns and associated behaviors. Since this type of therapy has been around for decades, there's significant research behind it in regard to its effectiveness in treating conditions such as depression, anxiety, and trauma-related disorder like PTSD.

Behavioral activation

Behavioral activation is a type of CBT. Mental health conditions like PTSD and depression can cause a person to lose motivation and isolate themselves. These behaviors can complicate your self-care routine. Instead of focusing on examining thoughts directly, behavioral activation focuses on acting first. 

The goal of this type of therapy may be shifting how you think and feel by allowing you to repeat behaviors until they become habits. If you often avoid specific thoughts or feelings, behavioral activation may teach you strategies for becoming more present in your actions and body. 

Eye movement desensitization and reprocessing therapy (EMDR)

EMDR is a type of psychotherapy that involves directing eye movements or body movements through bilateral stimulation. Bilateral stimulation involves both sides of your brain being stimulated simultaneously as you reprocess your trauma to allow you to use the left and right brain to remember the experience without being retraumatized by it. EMDR is often one of the most effective forms of treatment for PTSD, as it was developed to treat the condition specifically. 

Getty/Vadym Pastukh
Explore PTSD and the DSM-5 criteria for diagnosis

Counseling options 

You may have mixed feelings about seeking help. However, you’re not alone. If your symptoms make you feel nervous about going to a therapist’s office, you might try online therapy. Research has found that online therapy is highly effective in treating PTSD, with results similar to studies on in-person therapy. Other studies have found that online counseling is more cost-effective.

Through an online platform like BetterHelp, you can sign up to get matched with a counselor within 48 hours. When you sign up, you can indicate whether you’re looking for a specific therapeutic modality or specialty, and you may be matched with a therapist with experience in treating PTSD. Once matched, you can also choose between phone, video, or live chat sessions, offering control over the way you receive treatment. 

Takeaway

The symptoms of PTSD can be challenging to cope with, and PTSD may also be challenging to treat due to avoidance symptoms. However, you’re not alone, and there are many therapeutic modalities that have been found effective for this condition. In addition, if you don’t find a therapist or modality effective, there are over 400 modalities available in the psychological industry, allowing you to try multiple forms of treatment until you find one that works. Consider reaching out to a counselor to learn more and get started.
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