diagnostic criteria

Last reviewed 01/2018

Diagnostic and Statistical Manual of Mental Disorders (DSM – V)

• has defined traumatic event(s) required for diagnosis of PTSD:
• exposure to actual or threatened death, serious injury, or sexual violation, in one or more of the following ways:
• direct experiencing the traumatic event(s)
• witnessing traumatic event(s) in others
• learning that traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or unintentional
• experiencing repeated or extreme exposure to aversive details of the traumatic event(s) e.g. - first responders collecting human remains; police officers repeatedly exposed to details of child abuse
• this does not apply to exposures through electronic media, television, movies, or pictures, unless this exposure is work related
• diagnosis of PTSD can be made when a patient displays an impaired ability to function normally for a period of one month
• delayed presentation, in some instances years after the traumatic event, is common and in these patients the effects are severe
• symptoms required for diagnosis include:      
• intrusion symptoms
• recurrent, involuntary and intrusive distressing memories
• recurrent distressing dreams (content and/or affect related) 
• dissociative reaction (acting or feeling as if event is recurring)
• intense or prolonged psychological distress to cues
• noticeable physiological reactions to cues
• avoidance
• avoidance or efforts to avoid distressing thoughts or feelings about or closely associated with the trauma
• avoidance or efforts to avoid external reminders (people, places, conversations, activities, objects, situations)
• negative alterations in cognitions and mood
• inability to remember an important aspect (typically due to dissociative amnesia)
• persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (for example, “I am bad,” “No one can be trusted,” “The world is completely dangerous”)
• persistent, distorted cognitions about the cause or consequences that lead to self blame or the blame of others
• persistent negative emotional state (for example, fear, horror, anger, guilt, shame)
• noticeably diminished interest or participation in important activities
• feelings of detachment or estrangement from others
• persistent inability to experience positive emotions (for example, happiness, satisfaction, love)
• alterations in arousal and reactivity
• irritable behaviour and angry outbursts (with little or no provocation)
• reckless or self destructive behaviour
• hypervigilance
• exaggerated startle response
• problems with concentration
• sleep disturbance

Proposed ICD-11

• criterion defining traumatic event
• exposure to and extremely threatening or horrific event or series of events
• symptoms required for diagnosis include:
• intrusion symptoms
• vivid intrusive memories, flashbacks, or nightmares, typically accompanied by strong and overwhelming emotions such as fear or horror, and strong physical sensations
• avoidance
• avoidance of thoughts and memories of the event or events
• avoidance of activities, situations, or people reminiscent of the event or events
• negative alterations in cognitions and mood
• not applicable
• alterations in arousal and reactivity
• persistent perceptions of heightened current threat—for example, as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises
• additional criteria for complex PTSD
• severe and pervasive problems in affect regulation
• persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by deep and pervasive feelings of shame, guilt, or failure related to the stressor
• persistent difficulties in sustaining relationships and in feeling close to others

Reference:

• (1) Bisson JI et al. Post-traumatic stress disorder. BMJ. 2015;351:h6161