PTSD diagnostic criteria from the DSM

PTSD diagnostic criteria from the DSM-III

Post-traumatic Stress Disorder (309.89)

Essential feature. Characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The original stressor is usually experienced with intense fear, terror, and/or helplessness.

The precipitating stressor must not be one which is usually well tolerated by most other members of the cultural group (e.g., death of a loved one, ordinary traffic accident). Post-traumatic Stress Disorder need not develop in every victim. Traumas may be experienced alone, e.g., rape, severe physical assault) or in groups (e.g., military combat, unusually serious automobile accidents). The stressor may arise from natural, accidental, or purposeful events.

Age-specific features. The disorder in children may present differently (see below).

Associated features. Depression and anxiety are common and may be diagnosed as separate disorders. Compulsive behavior or changes of routine or lifestyle may occur. Pseudo -"organic" symptoms, such as memory problems, difficulty in concentrating, or emotional liability, may occur and may be confused with Somatoform Disorders. "Survivor's guilt" may occur, particularly if others were killed in the traumatic event. Impairment may be mild or severe and may affect almost any aspect of life. Phobic avoidance of real or symbolic reminders of the trauma may occur.

Differential diagnosis: If criteria for Anxiety Disorders, Depressive Disorders, or Organic Mental Disorders are fully met, these diagnoses should also be made. "Adjustment Disorder" implies a less severe trauma, and the patient does not meet all of the criteria listed below.

Diagnostic criteria for Post-Traumatic Stress Disorder:

A. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.

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

1. recurrent and intrusive, distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)

2. recurrent distressing dreams of the event

3. sudden acting or feeling as if the traumatic event were recurring (including "flashback" or dissociative episodes, whether or not intoxicated)

4. intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness, as indicated by at least three of the following:

1. efforts to avoid thoughts or feeling associated with the trauma

2. efforts to avoid activities or situations that arouse recollections of the trauma

3. inability to recall an important aspect of the trauma (psychogenic amnesia)

4. markedly diminished interest in significant activities (in young children, loss of recently acquired developmental skills such as toilet training or language skills)

5. feeling of detachment or estrangement from others

6. restricted range of affect

7. sense of foreshortened future (e.g., the patient does not expect to live very long or to have a successful career)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

1. difficulty falling or staying asleep

2. irritability or outbursts of anger

3. difficulty concentrating

4. hyper vigilance

5. exaggerated startle response

6. physiological activity upon exposure to events that symbolize or resemble an aspect of the traumatic event

E. Duration of disturbance (symptoms in "B," "C," and "D") of at least one month.

Specify: "delayed onset" if symptom onset occurs at least six months after the traumatic event. Age-specific features. The disorder in children may present differently.