What Is Post-traumatic Stress Disorder? DSM-5 Criteria, Symptoms, And Treatment

As a result of experiencing or witnessing a traumatic event or repeated traumatic events, many people become preoccupied with thoughts, memories, and emotions reminding them of what occurred. For some people, these feelings fade, and the individual can process their feelings surrounding the event. However, a lingering trauma response may signal the existence of post-traumatic stress disorder (PTSD). 

PTSD is a serious mental health condition that can produce debilitating mental and physical symptoms. To help you better understand PTSD, it may be valuable to understand DSM-5 criteria, standard treatment methods, and how to support yourself at home.

What is PTSD?

Post-traumatic stress disorder (PTSD) is listed as a trauma and stressor-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is characterized by intense emotional responses, pervasive memories, and avoidance behaviors resulting from a traumatic event. 

Traumatic events can include experiencing or witnessing combat, natural disasters, domestic violence, sexual assault, death, neglect, and violent crime. Approximately one in every three people who experience a traumatic event develop PTSD. 

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An individual with PTSD may experience flashbacks (vivid memories that feel like reliving the trauma), nightmares, or responses to stimuli that remind them of the event. These experiences can produce emotional and physiological symptoms like anxiety, depression, or chronic pain. In addition to these mental and physical symptoms, the individual may also go to lengths to avoid experiencing reminders of the event. 

PTSD can be unpredictable because it does not necessarily develop immediately after a trauma. Symptoms may appear months or years after the event.  

DSM-V criteria for PTSD

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The DSM-5 is a resource that helps medical and mental health professionals determine whether an individual fulfills the criteria for specific mental health conditions. The PTSD DSM-5 criteria include four symptom categories and a list of twenty symptoms.

According to the DSM-5, a post-traumatic stress disorder diagnosis can be provided when a certain number of symptoms from each category below are met. One or more symptoms from each of the following four symptom groups (A, B, C, and D) must be experienced.  

A. Stressors

This criterion looks at how the individual was exposed to the traumatic event. The following forms of exposure to trauma can fit this criterion:

• Direct involvement in the event
• Witnessing the event
• Finding out a relative experienced a traumatic event 
• Indirect exposure due to external factors, such as a specific career (first responder work, military experience, etc.) 

B. Intrusion

This criterion is met when the individual experiences or re-lives the trauma repeatedly through the following triggers:

• Nightmares and flashbacks
• Intrusive and vivid memories 
• Emotional and physical distress when encountering stimuli that reminds them of the trauma, such as an anniversary, location, person, or topic 

C. Avoidance

This criterion is met when the individual makes efforts not to encounter stimuli related to the trauma they endured. The avoidance can happen in two ways:

• Avoiding memories or emotions related to the event 
• Avoiding stimuli that remind the individual of the event

D. Cognition and mood symptoms

Two or more symptoms from the following groups (D and E) must also be met. The D criterion is met when the individual experiences thoughts, emotions, and feelings that started or worsened after the traumatic event occurred, including:

• Lack of interest in daily activities or previously enjoyed activities 
• Increased isolation or withdrawal 
• Feeling negative about oneself and one’s surroundings
• Difficulty thinking of positive memories or experiencing positive emotions 
• Difficulty remembering key details surrounding the traumatic event
• Blaming themselves or others for the traumatic event
• Dissociation, depersonalization, or derealization 

E. Reactivity and arousal symptoms

This criterion is met when the individual experiences reactions related to the trauma, which started or worsened after the traumatic event occurred, including:

• Aggressive or irritable behavior
• Sleep disruptions
• Difficulty with concentration and focusing
• Risky behavior 
• Increased vigilance, paranoia, and hyperawareness of surroundings 
• Feeling startled easily by noises or reminders of the traumatic event 

F. Impairment

The individual’s symptoms must cause significant distress and impede their ability to function to meet the criteria for PTSD. 

G. Duration

The individual’s symptoms must have persisted for at least a month to meet the criteria in the DSM-5.

H. Source

For a diagnosis, the symptoms must not be caused by physical health symptoms due to a substance or medical condition. If your healthcare provider finds that symptoms from each group have been met, they may provide a diagnosis and determine what treatment options best suit your needs.

Treatment options for PTSD 

Post-traumatic stress disorder treatment often involves a primary focus on psychotherapy. Depending on the situation, medication might be prescribed to help the individual manage severe anxiety or nightmares. However, consult your doctor before starting, changing, or stopping medication.

Cognitive behavioral therapy (CBT) 

One method for treating post-traumatic stress disorder is cognitive-behavioral therapy (CBT), which may help individuals better understand the connection between their thoughts and potential maladaptive behaviors and emotions. For example, a therapist may help the client realize that their belief that the traumatic event will occur again leads to worry and tension. 

CBT can be done in an individual session or via group therapy. Symptom relief may be quicker than other formats because it’s typically a short-term therapy. During sessions with the therapist, the provider may encourage the individual to talk about their experiences and work with them to identify maladaptive thought patterns contributing to unwanted behaviors or symptoms. 

Note that CBT may not be effective for everyone with post-traumatic stress disorder, as it takes a behavioral approach. Some people with PTSD may seek validating, emotional, or somatic approaches instead. In these cases, other formats, like EMDR, IFS, or somatic experiencing therapy, may be more effective. 

Prolonged exposure therapy 

With prolonged exposure therapy (PET), the client gradually confronts their traumatic memories so that they’re able to form healthier associations with the event. PET may also be a short-term therapy, and sessions can last up to two hours. During these sessions, the therapist can help the client understand their fears and discuss why worst-case scenarios may not be a threat. 

Eye movement desensitization and reprocessing (EMDR)

The purpose of eye movement desensitization and reprocessing (EMDR) is to help the participant focus internally on the traumatic event while experiencing bilateral brain stimulation. Bilateral stimulation can involve the therapist using hand movements, passing a ball back and forth between the hands, offering non-painful hand buzzers, or using lights to draw attention from both eyes. 

EMDR may reduce the severity of adverse emotions and memories surrounding the event. It is an intensive form of therapy that can require weekly sessions for a few months to a year. At the end of treatment, the goal may be changing how the individual views their memories of the events and taking the emotional significance away from them to move forward. Seven out of ten studies have found EMDR more effective than CBT for post-traumatic stress disorder, as it was developed specifically to treat the condition. 

Somatic therapy 

Somatic experiencing therapy focuses on how trauma impacts the body. Traumatic events, especially childhood events, have been associated with adult chronic pain, headaches, physical illness, reduced immune system, and inflammation. Somatic experiencing therapy looks at how these symptoms can be reduced by driving awareness to the body instead of the mind. 

Clients may start identifying bodily sensations with a therapist while discussing traumatic events. Their therapist might ask them which body part they’re feeling it in, what it feels like, and what emotion might be associated with it. Emotions like anger can be associated with stomach pain or feelings of hotness under the skin. Through somatic therapy, clients can learn to identify their emotions and pinpoint where trauma is held in their bodies. Studies have found that somatic experiencing therapy can reduce PTSD symptoms. However, this therapeutic modality is newer, so further studies may be beneficial. 

Medication

Pharmacological solutions, like anti-depressants or anti-anxiety medications, may also be utilized to manage symptoms. Certain medications might be used to assist in sleeping or reducing insomnia. Others might help provide PTSD treatment by limiting the occurrence of flashbacks and nightmares. 

Medication is often a temporary solution to help individuals manage the immediate physical and emotional symptoms of PTSD while attending therapy. These medications might help you stay focused during therapy and improve overall treatment outcomes. Consult a healthcare professional before starting, changing, or stopping any medication.

Alternative counseling options 

For some people with post-traumatic stress disorder, leaving home for treatment might be difficult. Hypervigilance, anxiety, or difficulty trusting others can make an in-person therapy session feel too vulnerable. In these cases, online therapy might be beneficial, as it can be attended from home in a way that feels comfortable to each client. 

Research shows that online therapy can help people living with trauma manage their symptoms. In a meta-analysis that included 12 trials and over 1,300 participants, researchers concluded that online cognitive-behavioral therapy was an effective treatment for PTSD. The analysis also noted the increased accessibility provided by online therapy could bridge the treatment gap that often exists due to barriers to healthcare. 

Online therapy is an accessible and convenient form of care for those living with trauma, anxiety, or similar mental health challenges. With an online therapy platform like BetterHelp, you can work through symptoms of PTSD remotely, which can help if you’re not yet comfortable discussing trauma in person. The large number of therapists available on a virtual platform may also make it easier to find a provider who is trained in providing focused post-traumatic stress disorder (PTSD) care.