PTSD Symptoms: 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.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
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
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.
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
How does PTSD get diagnosed?
A person may develop PTSD after a traumatic life event or series of events. The diagnosis of post-traumatic stress disorder (PTSD) typically involves a comprehensive assessment conducted by a qualified mental health professional. This assessment is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and it includes the following steps:
- Clinical Interview: The first step is a thorough clinical interview. The mental health professional will ask the individual about their current symptoms, their trauma history, and any other relevant information or risk factors related to their mental health and life circumstances.
- Trauma history assessment: The clinician will inquire about the nature of the traumatic event(s) experienced by the individual. This includes gathering details about the event(s), the individual's emotional response at the time, and any subsequent effects on their life.
- Assessment of symptoms: The clinician will assess whether the individual is experiencing the specific symptoms associated with PTSD. These symptoms are grouped into four clusters: intrusion symptoms, avoidance, negative alterations in mood and cognition, and alterations in arousal and reactivity.
- Duration of symptoms: The symptoms must persist for more than one month to meet the criteria for a PTSD diagnosis. The clinician will assess the duration and severity of symptoms to determine if they meet this criterion.
- Functional impairment: A diagnosis of PTSD also requires that the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. The clinician will assess the impact of symptoms on the individual's daily life and functioning.
- Rule out other conditions: The clinician will consider other possible explanations for the symptoms and rule out other mental health conditions or medical conditions that may be contributing to the individual's distress.
- Differential diagnosis: In some cases, individuals may present with symptoms that are similar to PTSD but do not meet all the diagnostic criteria. The clinician may provide a diagnosis of "subthreshold" or "partial" PTSD if appropriate.
- Assessment tools: The clinician may use validated assessment tools, such as the Clinician-Administered PTSD Scale (CAPS-5) or the Posttraumatic Stress Disorder Checklist (PCL-5), to gather additional information and assess symptom severity.
- Medical examination: In some cases, a medical examination or laboratory tests may be conducted to rule out medical conditions that could be contributing to the symptoms.
It's important to emphasize that only a licensed mental health professional, such as a psychiatrist, psychologist, clinical social worker, or therapist, can make a formal diagnosis of PTSD. Self-diagnosis is not a substitute for a professional evaluation. If you or someone you know is experiencing symptoms of PTSD or has been exposed to traumatic events, it is important to seek help from a mental health professional for an accurate assessment and appropriate treatment.
What are the 20 core symptoms of PTSD?
Post-traumatic stress disorder (PTSD) is a complex mental health condition that can result from exposure to traumatic events. Individuals with PTSD may experience a wide range of symptoms that affect their thoughts, emotions, behaviors, and overall well-being. Here is a consolidated list of 20 core symptoms commonly associated with PTSD, reflecting the diverse ways in which this condition can manifest.
- Recurrent, distressing memories of the traumatic event(s).
- Distressing dreams related to the traumatic event(s).
- Flashbacks or a sense of reliving the traumatic event(s).
- Intense psychological distress or physiological reactions when exposed to reminders of the event(s).
- Avoidance of distressing memories, thoughts, or feelings associated with the event(s).
- Avoidance of external reminders, such as places, people, conversations, or activities, that trigger distressing memories or feelings.
- Inability to remember important aspects of the traumatic event(s).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
- Persistent distorted thoughts about the cause or consequences of the traumatic event(s).
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feeling detached from others or experiencing a sense of emotional numbness.
- Irritability or angry outbursts.
- Reckless or self-destructive behavior.
- Hypervigilance (constantly being on guard).
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbances.
- Chronic psychological distress.
- Impaired social and occupational functioning.
In addition to experiencing these symptoms, PTSD may also influence the risk of developing an anxiety disorder or depression. Managing symptoms and seeking support from a mental health professional may be beneficial for individuals with PTSD.
Is PTSD a DSM-5 diagnosis?
Yes, post-traumatic stress disorder (PTSD) is a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 is a widely used manual for the classification and diagnosis of mental health disorders, and it provides criteria and guidelines for the diagnosis of various conditions, including PTSD, anxiety disorders, and depression.
What are three unhealthy coping skills for PTSD?
Individuals with post-traumatic stress disorder (PTSD) may employ a variety of coping mechanisms to manage their distress, and some of these coping skills can be unhealthy or maladaptive. Here are three unhealthy coping skills that individuals with PTSD may use:
Substance Abuse: According to the Substance Abuse and Mental Health Services Administration, some individuals with PTSD may turn to alcohol, drugs, or other substances as a way to numb their emotional pain or temporarily escape from their symptoms. Substance abuse can provide short-term relief but often exacerbates symptoms over time and can lead to addiction and other negative consequences.
Avoidance: Avoidance is a common symptom of PTSD, and while it can serve as a coping mechanism in the short term, it can become unhealthy when taken to an extreme. Avoidance may involve avoiding places, people, activities, or conversations that trigger traumatic memories or emotional distress. Over time, excessive avoidance can limit an individual's ability to engage in important life activities and maintain relationships.
Isolation: Some individuals with PTSD may withdraw from social interactions and isolate themselves from friends, family, and support systems. While isolation may provide a sense of safety and control, it can lead to feelings of loneliness, depression, and further exacerbate PTSD symptoms. Social support is often a crucial element in recovery from PTSD, so isolation can hinder the healing process.
Does PTSD ever go away?
Post-traumatic stress disorder (PTSD) is a complex and chronic condition, but it is not necessarily a lifelong or permanent condition for everyone. After developing PTSD, the symptoms and duration can vary widely among individuals, and while it may persist for some, it can improve or remit for others, especially with appropriate treatment and support.
Treatments for PTSD may include exposure therapy, cognitive behavioral therapy, or medications like selective serotonin reuptake inhibitors. Lifestyle changes such as avoiding triggers in the beginning, eating well, and exercising can all help to manage symptoms and negative feelings related to PTSD.
How does a person with PTSD behave?
A person with post-traumatic stress disorder (PTSD) may exhibit a wide range of behaviors and symptoms, which can vary in intensity and presentation among different individuals. It's important to recognize that the expression of PTSD can be influenced by factors such as the nature of the trauma, the individual's coping mechanisms, and their level of social support. Common behaviors and signs associated with PTSD may include:
Re-experiencing Trigger Symptoms:
- Flashbacks: Individuals with PTSD may suddenly and vividly relive the traumatic event, feeling as if it is happening again.
- Nightmares: Disturbing dreams related to the trauma are common.
- Intrusive Thoughts: They may have persistent and distressing memories or thoughts about the traumatic event.
Avoidance and Numbing:
- Avoidance of Triggers: People with PTSD often go to great lengths to avoid reminders of the trauma, which can include avoiding certain places, people, or activities.
- Emotional Numbing: They may have difficulty experiencing positive emotions and may feel emotionally detached or "numb" to the world around them.
Hyperarousal and Reactivity:
- Irritability: Individuals with PTSD may become easily irritable or have frequent outbursts of anger.
- Hypervigilance: They may be constantly on high alert, feeling as though danger is always present.
- Exaggerated Startle Response: Sudden noises or unexpected events can trigger strong physical and emotional reactions.
- Problems with Concentration: Many people with PTSD find it challenging to concentrate on tasks.
Sleep Disturbances: Insomnia, frequent awakenings, and nightmares are common.
Negative Changes in Mood and Cognition:
- Negative Self-Perception: They may have persistent negative beliefs about themselves, others, or the world.
- Guilt and Shame: Feelings of guilt or shame related to the traumatic event may be prominent.
- Detachment: They may feel emotionally detached from others and experience a sense of isolation.
Changes in Social and Occupational Functioning:
- Difficulty in Relationships: PTSD can strain relationships due to emotional numbness, avoidance behaviors, and difficulty communicating.
- Work or School Problems: Impaired concentration and emotional distress can affect job performance or academic functioning.
What should a person with PTSD avoid?
Individuals with post-traumatic stress disorder (PTSD) often engage in avoidance behaviors as a way to cope with their symptoms and emotional distress. While avoidance can provide short-term relief, it can also reinforce the impact of PTSD and limit the individual's ability to heal and recover. Here are some things that individuals with PTSD may try to avoid but should consider addressing with the guidance of a mental health professional:
- Trauma triggers: Avoiding situations, places, people, or activities that remind them of the traumatic event(s) is a common avoidance behavior in PTSD. However, prolonged avoidance can maintain the fear response associated with these triggers. With the help of a therapist, individuals can gradually confront and process these triggers to reduce their distress.
- Emotional expression: Some individuals with PTSD may avoid expressing their emotions, particularly the distressing ones related to the trauma. This emotional numbness can hinder emotional healing. It's important to work on recognizing, processing, and expressing emotions in a safe and therapeutic context.
- Social isolation: Many people with PTSD withdraw from social interactions and isolate themselves from friends and family. While this may provide a sense of safety, it can lead to feelings of loneliness and exacerbate symptoms. Engaging in social support networks and relationships can be an important part of healing.
- Seeking treatment: Some individuals may avoid seeking professional help for their symptoms due to fear, stigma, or a belief that they can handle the situation on their own. Seeking treatment from a qualified mental health professional is a crucial step in managing and recovering from PTSD.
- Reminders of the trauma: Avoiding anything related to the traumatic event(s) may include avoiding conversations about it, which can prevent processing and healing. In therapy, individuals are encouraged to discuss and process their experiences.
- Self-medication: Avoiding the emotional pain and distress of PTSD symptoms, some individuals may turn to substances like alcohol, drugs, or other forms of self-medication. This can lead to addiction and worsen mental health symptoms. Seeking healthier coping strategies is essential.
How do you know if you are traumatized?
Recognizing if you have been traumatized can sometimes be challenging, as trauma reactions can vary widely among individuals. Trauma can result from various types of distressing experiences, such as accidents, surviving a natural disaster, violence, physical or sexual assault, or abuse. Here are some common signs and reactions that may indicate you have experienced trauma:
- Intrusive thoughts: You may have recurrent and distressing thoughts or memories about the traumatic event(s). These thoughts can intrude into your daily life and lead to distressing emotional reactions.
- Flashbacks: You might experience vivid and distressing flashbacks, during which you feel as though you are reliving the traumatic event(s). Flashbacks can be triggered by reminders of the trauma.
- Nightmares: Disturbing dreams related to the trauma may occur regularly, causing sleep disturbances and distress.
- Avoidance: You may go to great lengths to avoid situations, places, people, or activities that remind you of the traumatic event(s). Avoidance can be a way to manage emotional distress but can also limit your life.
- Emotional numbing: You might find it difficult to experience positive emotions or feel emotionally detached or "numb." Emotional numbness can affect your ability to connect with others and enjoy life.
- Irritability and anxiety: You may become easily irritable, anxious, or on edge, even in non-threatening situations.
- Hypervigilance: Feeling constantly on high alert or overly vigilant for potential threats can be a common response to trauma.
- Exaggerated startle response: Sudden noises or unexpected events may trigger strong physical and emotional reactions.
- Negative changes in mood and cognition: Trauma can lead to persistent negative beliefs about yourself, others, or the world. You may experience guilt, shame, or negative self-perception.
- Difficulty concentrating: Many individuals with trauma have difficulty concentrating on tasks, making decisions, or organizing their thoughts.
- Physical symptoms: Some people experience physical symptoms, such as headaches, gastrointestinal issues, or chronic pain, which may be linked to their emotional distress.
- Changes in relationships: Trauma can strain relationships due to emotional numbness, avoidance behaviors, and communication difficulties.
- Increased substance use: In an effort to cope with distress, some individuals may increase their use of alcohol, drugs, or other substances.
What is the most serious type of PTSD?
Post-traumatic stress disorder (PTSD) can have a significant impact on an individual's life, and the severity of PTSD can vary among individuals based on several factors, including the nature and duration of the traumatic event(s), the individual's resilience, and their capacity to support and treatment. It's important to note that there isn't a single "most serious" type of PTSD, as the condition itself can manifest in different ways and at varying levels of severity.
However, some individuals may experience what is often referred to as "complex PTSD" or "C-PTSD." Complex PTSD typically results from prolonged exposure to traumatic events or repeated traumatic experiences, such as ongoing abuse, neglect, or captivity. It is characterized by more severe and enduring symptoms than standard PTSD and often involves disturbances in self-identity, emotional regulation, and interpersonal relationships.
Do people with PTSD lack empathy?
People with post-traumatic stress disorder (PTSD) do not inherently lack empathy. Empathy is the ability to understand and tell the feelings of others, and it is a complex emotional response that can be influenced by various factors, including an individual's mental health and emotional state. However, individuals with PTSD may experience certain emotional and interpersonal challenges that can sometimes affect their ability to express empathy or connect with others in the same way they did before experiencing trauma.
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