What are the DSM-5 diagnostic criteria for posttraumatic stress disorder (PTSD)?

Updated: Nov 14, 2018
  • Author: T Allen Gore, MD, MBA, CMCM, DFAPA; Chief Editor: David Bienenfeld, MD  more...
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Diagnosing PTSD in adults, adolescents, and children older than 6 years of age using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1]  requires a certain type and level of traumatic event, a combination of required symptoms, and the absence of exclusionary criteria. 

A) Causation: The victim was exposed to actual or threatened death, serious injury or sexual violence in one of four ways:

  • Directly experiencing the traumatic event(s)

  • Witnessing, in person, the event(s) as it occurred to others

  • Learning that the traumatic event(s) occurred to a close family member or friend

  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures

B) The traumatic event is persistently re-experienced:

  • Nightmares

  • Intrusive thoughts of the traumatic event

  • Flashbacks

  • Marked emotional distress when exposed to traumatic reminders

  • Strong physiologic reaction when exposed to traumatic reminders

Children may re-experience the event through repetitive play.

C) Avoidance in one of two ways:

  • Avoidance of thoughts, feelings, or conversations associated with the event

  • Avoidance of people, places, or activities that may trigger recollections of the event

D) Negative alterations in cognition and mood.  Two of the following:

  • Inability to remember an important aspect of the event(s)

  • Persistent and exaggerated negative beliefs about oneself, others, or the world

  • Persistent distorted cognitions about the cause or consequences of the event(s)

  • Persistent negative emotional state

  • Markedly diminished interest or participation in significant activities

  • Feelings of detachment or estrangement from others

  • Persistent inability to experience positive emotions

E) Hyperarrousal: Two of the following:

  • Irritable behavior and angry outbursts

  • Reckless or self-destructive behavior

  • Hypervigilance

  • Exaggerated startle response

  • Concentration problems

  • Sleep disturbance

F) The duration of symptoms is more than 1 month

G) Disturbance causes clinically significant distress or impairment in functioning

H) The disturbance is not attributable to the physiological effects of a substance or other medical condition

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