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DSM-5 And PTSD

BY THOMAS C. HALL, PhD., CHAIR

In 2013 the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The VA’s National Center for PTSD has compiled a review of those changes, which we are republishing below. These criteria are specific to adults, adolescents, and children older than six years. If they seem uncomfortably familiar, contact a professional or call the VA’s PTSD Crisis Lifeline at 800-273-TALK (8255).

Criterion A: stressor
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

• Direct exposure.
• Witnessing, in person.
• Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
• Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts, professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)

• Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
• Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
• Dissociative reactions (e.g., flashbacks), which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
• Intense or prolonged distress after exposure to traumatic reminders.
• Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required)

• Trauma-related thoughts or feelings.
• Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

• Inability to recall key features of the traumatic event (usually dissociative amnesia, not due to head injury, alcohol, or drugs).
• Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous”).
• Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
• Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
• Markedly diminished interest in (pre-traumatic) significant activities.
• Feeling alienated from others (e.g., detachment or estrangement).
• Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

• Irritable or aggressive behavior.
• Self-destructive or reckless behavior.
• Hypervigilance.
• Exaggerated startle response.
• Problems in concentration.
• Sleep disturbance.

Criterion F: duration

Persistence of above symptoms for more than one month.

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion

Disturbance is not due to medication, substance use, or other illness.