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What Are the DSM Criteria for PTSD?

What Are the DSM Criteria for PTSD?In 2000, the American Psychiatric Association (APA) revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). According to the APA a person must have a history of exposure to a traumatic event to be diagnosed with PTSD. There is no specific description for the type of trauma, and trauma may include the following:

  • Assault
  • Domestic abuse
  • Prison stay
  • Rape
  • Terrorism
  • War

According to the APA diagnostic requirements, a person with PTSD must have been exposed to a traumatic event in which both of the following were present:

  • The person experienced, witnessed or was confronted with an event or events that involve actual or threatened death or serious injury or a threat to the physical integrity of oneself or others.
  • The person’s response involved intense fear, helplessness or horror. In children, it may be expressed instead by disorganized or agitated behavior.

The definition of the stressor allows for both direct exposure and indirect exposure to the traumatic event.

Symptom Clusters for PTSD

APA has put the criteria for a PTSD diagnosis into the following three clusters:

  • Intrusive recollections
  • Avoidant and numbing symptoms
  • Hyper-arousal symptoms

APA further defines PTSD by the duration of the symptoms and how PTSD impacts a person’s ability to function.

Intrusive Recollections

The traumatic event is persistently re-experienced in at least one of the following ways:

  • The individual experiences recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  • The individual experiences recurrent distressing dreams of the event. In children, there may be frightening dreams without recognizable content.
  • The individual acts or feels as if the traumatic event were recurring, which can include a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, such as those that occur upon awakening or when intoxicated. In children, trauma-specific reenactment may occur.
  • The individual experiences intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  • The individual experiences physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

The focus on this part of the definition deals with the person’s reaction to the traumatic event.

Avoidant and Numbing Symptoms

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) can be indicated by at least three of the following:

  • Efforts to avoid thoughts, feelings or conversations associated with the trauma
  • Efforts to avoid activities, places or people that arouse recollections of the trauma
  • Inability to recall an important aspect of the trauma
  • Markedly diminished interest or participation in significant activities
  • Feelings of detachment or estrangement from others
  • Restricted range of effects, such as an inability to have loving feelings
  • Sense of foreshortened future, for example not having expectations to have a career, marriage, children or a normal life span

This section deals with how a person reacts to the intrusive recollections.

Hyper-Arousal Symptoms

Persistent symptoms of increasing arousal (not present before the trauma) can be indicated by at least two of the following:

  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • Hyper-vigilance
  • Exaggerated startle response

As part of the diagnosis for PTSD and the associated recommended treatment, a psychologist will also factor in how long the person has demonstrated the symptoms and how significant these behaviors impair occupational and other important areas of functioning.

Get PTSD Treatment

If you or someone you love is suffering from PTSD, please call our toll-free number today. Our counselors are available 24 hours a day to answer any questions you have about PTSD treatment.