DSM-5 Criteria for PTSD

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD was included in a new category in DSM-5, Trauma- and Stressor-Related Disorders.

38 CFR Rating Disabilities 4.125 Diagnosis of mental disorders. (a) If the diagnosis of a mental disorder does not conform to DSM-5 or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.

DSM 5 has to do with how you are diagnosed with PTSD.  Criterion A. Have 1 symptom in B and C.  Have 2 symptoms in D and E.  Have the symptoms in F, G, and H.  See the below example.

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Criterion A: Stressors

Exposure or threat of death, serious injury, or sexual violence in one or more of the following ways:

• • You directly experienced the event.
  • You witnessed the event happen to someone else, in person.
  • You learned of a close relative or close friend who experienced an actual or threatened accidental or violent death.
  • You had repeated indirect exposure to distressing details of the event(s). This could occur in the course of professional duties (first responders, collecting body parts, or 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 one or more of the following ways:
  • Recurrent, involuntary, and intrusive memories. Children older than six may express this symptom through repetitive play in which aspects of the trauma are expressed.
  • Traumatic nightmares or upsetting dreams with content related to the event. Children may have frightening dreams without content related to the trauma.
  • Dissociative reactions, such as flashbacks, in which it feels like the experience is happening again. These may occur on a continuum ranging from brief episodes to complete loss of consciousness. Children may re-enact the events in the play.
  • Intense or prolonged distress after exposure to traumatic reminders.
    Marked physiological reactivity, such as increased heart rate, after exposure to traumatic reminders.

Criterion C: Avoidance

• • Persistent effortful avoidance of distressing trauma-related reminders after the event as evidenced by one or both of the following:2
  • Avoidance of trauma-related thoughts or feelings.
    Avoidance of trauma-related external reminders, such as people, places, conversations, activities, objects, or situations.

Criterion D: Negative Alterations in Mood

• • Negative alterations in cognition and mood that began or worsened after the traumatic event as evidenced by two or more of the following:2
  • Inability to recall key features of the traumatic event. This is usually dissociative amnesia, not due to head injury, alcohol, or drugs.
  • Persistent, and often distorted negative beliefs and expectations about oneself or the world, such as “I am bad,” or “The world is completely dangerous.”
  • Persistent distorted blame of self or others for causing the traumatic event or for the resulting consequences.
  • Persistent negative emotions, including fear, horror, anger, guilt, or shame.
  • Markedly diminished interest in activities that used to be enjoyable.
  • Feeling alienated, detached, or estranged from others.
  • Persistent inability to experience positive emotions, such as happiness, love, and joy.

Criterion E: Alterations in Arousal and Reactivity

• • Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event, including two or more of the following:
  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Feeling constantly “on guard” or like danger is lurking around every corner (hypervigilance)
  • Exaggerated startle response
  • Problems in concentration
  • Sleep disturbance

Criterion F: Duration

Persistence of symptoms in Criteria B, C, D, and E for more than one month.

Criterion G: Functional Significance

Significant symptom-related distress or impairment of different areas of life, such as social or occupational.

Criterion H: Exclusion

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