DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (2023)

Post traumatic stress disorder (PTSD) is a recognizedpsychiatric disorderthat a person may develop after exposure to a traumatic event. For many years, PTSD went widely undiagnosed or was not recognized as the serious condition it is.

Thanks to advancements in research and the breakdown of social stigmas, we have more information about the mental health condition than ever before.

We know that the majority of people who are exposed to traumatic events do not develop PTSD, and we know that veterans of the U.S. military aredisproportionately affected by PTSDwhen compared to American civilians.

This blog post provides a brief breakdown of the required criteria for a diagnosis of PTSD, as well as PTSD specifications, as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), published by the American Psychiatric Association. It’s important to note that this edition made changes to the previous DSM-IV.

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DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (1)

What PTSD Criteria Does The DSM-5 Include?

The DSM-5 outlines specific criteria that must be present. These include:

  • A stressor
  • Intrusive symptoms
  • Avoidance symptoms
  • Negative alterations in cognition and mood
  • Alternations in arousal and reactivity
  • Duration of symptoms
  • Functional significance
  • Exclusion

We will break down each of these PTSD DSM-5 criteria below.

Criterion A: Stressor

In the context of PTSD, the stressor is the traumatic event that leads to the development of PTSD. The precise definition of “traumatic event”is contested, but the DSM V requires exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.

These types of events can cause psychological distress and trigger a number of stressor-related disorders, but PTSD is among the most serious.

Exposure to this stressor must have occurred in one of the following ways:

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to the trauma
  • Indirect exposure to details of the trauma
DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (2)

Indirect exposure often occurs in the course of professional duties. For example, a paramedic treating victims of a serious motor vehicle accident would be indirectly exposed to the traumatic event of the motor vehicle accident even if she did not witness the accident herself.

Military service is a risk factor for PTSD due to frequent exposure to traumatic events, such as witnessing the death of fellow soldiers, witnessing injuries, discharging a weapon, participating in active combat, and experiencing general stress of deployment.

Experiences during active duty may lead to extreme exposure to these types of stressors.

(Video) Understanding DSM-5 Criteria for PTSD: A Disorder of Extinction

Criterion B: Intrusive symptoms

Not everyonewho is exposed to a traumatic event will develop PTSD. In order for a person to receive a diagnosis of PTSD, the DSM-V requires the person to show at least one intrusive symptom.

Intrusive symptoms can manifest in the following ways:

  • Sudden upsetting memories
  • Nightmares or bad dreams
  • Flashbacks to the traumatic event (mentally re-experiencing the trauma)
  • Emotional distress after reminders of the traumatic event
  • Physical reactivity following reminders of the traumatic event (for example, an increased heart rate after exposure to reminders of the traumatic event)

While the intrusive symptoms of PTSD can vary, these are some of the most common.

Criterion C: Avoidance symptoms

The third criterion for a PTSD diagnosis is avoidance of reminders of the trauma.

This could be an avoidance of thoughts or feelings about the event or avoidance of trauma-related reminders altogether. A person who suffered sexual assault may display avoidance of thoughts and feelings of the assault and do their best to never think about the event.

Someone who witnessed a person drowning may avoid trauma-related reminders and stay away from pools or bodies of water, for example.

In the case of military veterans, they may avoid any depictions of violence to avoid reminders of their own trauma. For a diagnosis of PTSD, the presence of at least one of these symptoms is required.

DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (3)

Criterion D: Negative alterations in cognition and mood

A person who receives a diagnosis of PTSD must display at least two of the following symptoms following the stressor:

  • Inability to recall key features of the stressor
  • Overly negative thoughts or assumptions about oneself or the world
  • Exaggerated blaming of self or of others for causing the trauma
  • Negative affect (having a flat or depressed mood)
  • Decreased interest in regular activities
  • Feelings of isolation
  • Difficulty experiencing a positive effect (having a hard time feeling happy)

Criterion E: Alterations in arousal and reactivity

For a diagnosis of PTSD, at least two of the following symptoms that began or worsened after the stressor must be present:

  • Irritability or aggression (such as having angry outbursts)
  • Risky or destructive behavior (for example, driving recklessly)
  • Hypervigilance (for example, not being able to relax for fear that something bad will happen)
  • Increased startle reaction
  • Difficulty concentrating; or sleep disturbances.
DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (4)

These alterations in arousal and reactivity are adefense mechanismfor preventing further trauma.

Criterion F: Duration of symptoms

Even if a person fulfills all the required criteria, a diagnosis of PTSD requires persistence of the symptoms for more than one month.

A person may fulfill all criteria immediately following a traumatic event but display fewer or none of the required symptoms two weeks after the event. Although the criteria were present for a time, the person would not meet the duration requirement.

Criterion G: Functional significance

The PTSD symptoms experienced by the person with the diagnosis must create distress or functional impairment in a person’s life.

For example, a veteran who suffers from PTSD and currently works in an office setting may find that he has difficulty concentrating and is irritable toward his coworkers. These symptoms may harm his job performance. A college student who experienced sexual assault at a party may find that their friendships are affected by their negative affect, hypervigilance, and avoidance of other social events.

(Video) Dr. Julian Ford - Post-Traumatic Stress Disorder Assessment & Treatment Planning

DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (5)

Criterion H: Exclusion

In order to meet the criteria for a PTSD diagnosis, the symptomsmust notbe caused by medication, substance abuse, or any other illness.

This is an extremely simplified discussion of PTSD intended to provide clarity to a frequently-discussed condition. Follow-up blogs will address specifications of the diagnosis, as well as how veterans can approach service connection for PTSD when seeking disability benefits from the Department of Veterans Affairs. Veterans and their family members can also learn more about this psychiatric disorder on the VA’sNational Center for PTSDwebsite.

What PTSD Specifications Does The DSM-5 Include?

It’s important to note that the DSM-5 also outlines two specifications for PTSD diagnoses. These specifications can apply to veterans who meet the eight PTSD criteria outlined above and have unique circumstances.

These specifications may not apply to every PTSD diagnosis.

Dissociative Specification

“Depersonalization is the experience of being detached from oneself and one’s surroundings.”

This specification applies to individuals who meet all PTSD criteria and who also experience dissociative symptoms when exposed to reminders of the traumatic event. One dissociative symptom is depersonalization, which is the experience of being detached from oneself and one’s surroundings or feeling like an outside observer or as if one is only dreaming.

DSM-5 PTSD Criteria: Diagnosing Post Traumatic Stress Disorder in Vets (6)

Some individuals may compares this sensation to a numbing feeling. Someone experiencing depersonalization may have an “out of body” experience.

Another symptom characteristic of a dissociative specification is derealization. With derealization, the individual may experience reminders of the trauma as though the reminders are not really happening, or believing the event or the reminders to be “unreal.”

Similarly to depersonalization, derealization is a way for the individual to mentally distance themselves from the traumatic event.

Delayed Specification

This specification applies when the full diagnostic criteria are not met until at least six months after the initial traumatic event.

In this specification, an individual may experience some symptoms immediately after the trauma but not the full range of symptoms required for a diagnosis. In other cases, an individual may seem to be functioning perfectly normally with no symptoms at all until some time passes or a significant event, such as the loss of a loved one or a life change such as a divorce or retirement, brings on worsening symptoms.

Regardless of when the symptoms appear, the individual must meet the full diagnostic criteria in order to receive a diagnosis of PTSD.

PSTD can cause significant distress, and a diagnosis is important for receiving the mental health care and financial help you need. In a follow-up to this blog post, will will discuss how veterans can obtain service connection for PTSD and how the VA rates this condition for disability compensation.

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(Video) PTSD - Posttraumatic stress disorder - Symptoms, Diagnosis, Causes, treatment, DSM-5

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(Video) PTSD - DSM-5 Criteria, how veterans can report symptoms, and VA claim PTSD stressors

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What are the DSM-5 criteria for giving a PTSD diagnosis? ›

What is the DSM-5 criteria for PTSD? The DSM-5 criteria for PTSD include, first, direct or indirect exposure to a traumatic event, followed by symptoms in four categories: intrusion, avoidance, negative changes in thoughts and mood, and changes in arousal and reactivity.

What is the A criteria for PTSD in both DSM-IV & V? ›

Criterion A: stressor (one required)

Direct exposure. Witnessing the trauma. Learning that a relative or close friend was exposed to a trauma. Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

What is the PTSD Checklist PCL? ›

The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including: Monitoring symptom change during and after treatment. Screening individuals for PTSD. Making a provisional PTSD diagnosis.

How does VA determine PTSD? ›

When assigning a disability rating for PTSD, VA will consider the frequency, duration, and severity of your symptoms along with the resulting level of social and occupational impairment. In other words, your disability rating reflects how you are affected both in your personal life and your work life.

What is the gold standard for diagnosing PTSD? ›

The CAPS is the gold standard in PTSD assessment. The CAPS-5 is a 30-item structured interview that can be used to: Make current (past month) diagnosis of PTSD.

What are the 4 symptom clusters of a DSM-5 PTSD diagnosis? ›

DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. They are described as re-experiencing, avoidance, negative cognitions and mood, and arousal.

What is the difference between DSM 4 and DSM-5 PTSD? ›

Whereas there were three major symptom clusters in DSM-IV—reexperiencing, avoid- ance/numbing, and arousal—there are now four symptom clusters in DSM-5, because the avoidance/ numbing cluster is divided into two distinct clusters: avoidance and persistent negative alterations in cognitions and mood.

How many criteria do you need to be diagnosed with PTSD? ›

Criteria for Diagnosis

To receive a diagnosis of PTSD, a person must have at least one re-experiencing symptom, at least three avoidance symptoms, at least two negative alterations in mood and cognition, and at least two hyperarousal symptoms for a minimum of one month.

Why is PTSD not in the DSM-5? ›

In the DSM-4, your response to a traumatic event was factored into the diagnosis, namely whether you felt overwhelming fear, helplessness, or horror. In the DSM-5, this criterion was removed because many felt it's such a common symptom that it can't accurately predict whether you'll develop PTSD.

How is PCL PTSD Checklist scored? ›

How is the PCL-5 scored and interpreted? Respondents are asked to rate how bothered they have been by each of 20 items in the past month on a 5- point Likert scale ranging from 0-4. Items are summed to provide a total severity score (range = 0-80).

What is the best assessment tool for PTSD? ›

Posttraumatic Stress Disorder Checklist (PCL-5)

It can provide a global assessment of PTSD severity both at the time of diagnosis and over the course of treatment. Self-report tool that assesses PTSD severity at the time of diagnosis and over the course of treatment.

What is a normal PCL-5 score? ›

A PCL-5 cut-point of 33 appears to be a reasonable value to use for provisional PTSD diagnosis. diagnosis of PTSD. maximize the detection of possible cases needing additional services or treatment. A higher cutoff score should be considered when attempting to minimize false positives.

Does the VA always reevaluate PTSD? ›

The rating you receive is assigned by the VA when your service connection is established. But PTSD can either improve or deteriorate over time. If it does either, VA may attempt to raise or lower your disability rating to match your current condition.

Is PTSD considered a permanent VA disability? ›

3. The veteran's total disability due to PTSD is permanent with no likelihood of improvement. The 100 percent rating for PTSD is total, permanent, and static in nature.

How do you score PTSD symptoms scale PSS? ›

Symptom items are rated on a 5-point scale of frequency and severity ranging from 0 (Not at all) to 4 (6 or more times a week / severe). Symptoms are considered present when rated 1 or higher. The sum of the 20 PTSD symptoms items yield a total PTSD symptom severity score, ranging from 0-80.

Can a blood test detect PTSD? ›

The doubts and stigma made many veterans hesitant to report their symptoms. Now, decades later, a new blood test shows promise in diagnosing PTSD by spotting genetic and cellular changes that accompany the disorder, suggesting that this condition is not just “all in the head.”

What are three of the four categories of symptoms required for a diagnosis of PTSD? ›

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions.

Does DSM-5 recognize complex PTSD? ›

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a handbook often used by psychiatrists and psychologists, does not currently acknowledge complex PTSD as a separate condition.

What conditions have to be met before a person can be diagnosed with post traumatic stress disorder? ›

To meet the criteria for PTSD, symptoms must last longer than 1 month, and they must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.

What are the 3 major elements of PTSD? ›

The diagnosis of PTSD usually focuses on three elements:

The avoidance of reminders of the trauma, as well as emotional numbing or detachment. This is associated with an inability to experience pleasure and with a general withdrawal from engagement with life.

How did the name of PTSD changed in the DSM-5? ›

PTSD is no longer considered an Anxiety Disorder but has been reclassified as a Trauma and Stressor-Related Disorder because it has a number of clinical presentations, as discussed previously. In addition, two new subtypes have been included in the DSM-5.

Can PTSD be mistaken for PTSD? ›

PTSD can be misdiagnosed as the symptoms or behaviors of other mental health conditions. Conditions such as anxiety, depression, acute stress disorder, and more, have similarities to PTSD. It is important to note that not everyone who experiences a traumatic event has PTSD.

How often is PTSD misdiagnosed? ›

In primary care (PC) settings, patients with post-traumatic stress disorder (PTSD), are often not diagnosed; 2% to 11% with PTSD actually have the diagnosis noted in the medical record.

Why PTSD was moved out of the anxiety classification? ›

What then is the reason for moving PTSD out of anxiety disorders and into the new trauma and stress disorders section? The main rationale is that PTSD often manifests with non-anxiety symptoms such as dissociative experiences, anger outbursts, and self-destructive behavior.

How accurate is the PCL 5? ›

The results indicated that PCL-5 scores showed strong internal consistency and convergent and discriminant validity. Signal detection analyses indicated a good diagnostic accuracy and an optimal cutoff score of 41 for detecting PTSD.

What are the four components of successful PTSD interventions? ›

Therapy (PE Therapy)

(PTSD) education; (2) breathing techniques to reduce the physiological experience of stress; (3) exposure practice with real-world situations; and (4) talking through the trauma.

What is the percentage for PTSD VA compensation? ›

PTSD disability ratings can be 10%, 30%, 50%, 70%, or 100%. Transparency about your worst symptoms is vital for your rating. VA often rates veterans by the average of their symptoms. So, if a veteran has such symptoms that fall in the 30, 50, and 70% PTSD rating ranges, they will often get a 50% PTSD rating.

Which instrument can be used clinically to adequately diagnose PTSD? ›

Davidson Trauma Scale (DTS)

The DTS is a 17-item, Likert-scale, self-report instrument that assesses the 17 DSM-IV symptoms of PTSD. Both a frequency and a severity score can be determined. The DTS can be used to make a preliminary determination about whether the symptoms meet DSM-IV criteria for PTSD.

What is a commonly used PTSD screening instruments? ›

PTSD Screening Instruments
  • Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)
  • SPAN.
  • Trauma Screening Questionnaire (TSQ)
24 Jun 2021

Is there a biomarker for PTSD? ›

Biomarkers of Heightened Inflammation in PTSD

Pro-inflammatory cytokines (i.e. proteins), including interleukin (IL)-6 (74), IL-1β (75), and IL-2 (76) are elevated in individuals with PTSD and peripheral levels of inflammatory markers correlate positively with PTSD symptomology (Figure 1) (77).

What does a PCL 5 score of 50 mean? ›

score of 50 is considered to be PTSD positive in military populations. A second way to. score the PCL is to treat “moderately” or above (responses 3 through 5) as symptomatic. and anything below “moderately” (1 and 2) as non-symptomatic.

Which is the most accurate test for the integrity of the PCL? ›

The posterior drawer test: This is the most accurate test for assessing PCL integrity. It is performed with the patient in a supine position with the hip flexed to 45 degrees and knee flexed to 90 degrees. A posterior force is applied to the proximal tibia whilst the femur is stabilized.

How is DSM-5 scored? ›

Scoring and Interpretation

Nineteen of the 25 items on the measure are each rated on a 5-point scale (0=none or not at all; 1=slight or rare, less than a day or two; 2=mild or several days; 3=moderate or more than half the days; and 4=severe or nearly every day).

How often does the VA reevaluate PTSD ratings? ›

Basically, the VA can reevaluate your disability rating every 2 to 5 years unless your rating is permanent or protected. Depending on the results of the reexamination and reevaluation, you may see a reduced rating.

What is the VA 55 year rule? ›

What is the VA 55-year-old rule? Veterans who receive VA disability benefits for service-connected conditions are exempt from periodic future examinations once they turn 55 years old. This includes veterans who will be 55 by the date of a future examination, according to the VA Adjudication Procedures Manual.

Is 50 PTSD a permanent VA disability? ›

As you can see, the automatic 50% rating for PTSD applies only in very limited cases and doesn't offer permanent benefits. The vast majority of Veterans will need to accurately document their symptoms and service-connected stressors to win their disability claim.

How does the VA verify PTSD claims? ›

Section 4.130, DC 9411. To obtain a VA disability rating for PTSD, a veteran must generally establish the following three elements: (1) a current diagnosis of PTSD; (2) a corroborated in-service stressor; and (3) medical evidence linking the PTSD diagnosis to the stressor. Sizemore v. Principi, 18 Vet.

How do I prove my VA disability for PTSD? ›

To prove a current medical condition for PTSD, you should have a medical diagnosis of PTSD and on-going treatment. Without a diagnosis and treatment, it is hard to persuade the VA to look closely at your claim, and they may deny your claim without sending you for a psychological exam. Not always – – but almost always.

How do veterans get PTSD rating? ›

To get disability compensation, veterans should submit a PTSD claim with VA. First, veterans can download and fill out VA Form 21-526EZ. This can be submitted via mail to the Claims Intake Center, in person at the closest VA Regional Office, or electronically through VA's website.

What is essential for PTSD diagnosis? ›

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways: You directly experienced the traumatic event. You witnessed, in person, the traumatic event occurring to others.

Which symptoms must be present to make an accurate diagnosis of PTSD? ›

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month: At least one re-experiencing symptom. At least one avoidance symptom.
Arousal and reactivity symptoms include:
  • Being easily startled.
  • Feeling tense or “on edge”
  • Having difficulty sleeping.
  • Having angry outbursts.

Can PTSD diagnosis be used as evidence? ›

Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense.

What is a common second diagnosis that goes with PTSD? ›

The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD.

Which four parts of the brain are affected by PTSD? ›

Your amygdala, prefrontal cortex, and hippocampus all contribute to the feelings and actions associated with fear, clear thinking, decision-making, and memory. Understanding how they work also might explain why some therapies can help you work through PTSD.

What is the most common occurring diagnosis in people with PTSD? ›

Among those diagnosed with PTSD, up to 48% develop major depression. 4 Depression, like anxiety, is a common mental health condition that affects millions of Americans every year. If you have PTSD, you likely have symptoms that overlap with those of clinical depression.

What are the 5 signs of PTSD? ›

Common symptoms of PTSD
  • vivid flashbacks (feeling like the trauma is happening right now)
  • intrusive thoughts or images.
  • nightmares.
  • intense distress at real or symbolic reminders of the trauma.
  • physical sensations such as pain, sweating, nausea or trembling.

What assessment tools are used for PTSD? ›

PTSD Screening Instruments
  • Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)
  • SPAN.
  • Trauma Screening Questionnaire (TSQ)
24 Jun 2021


1. Post-traumatic stress disorder (PTSD) - symptoms, DSM5 criteria, treatment
(Medic Notes)
2. Complete diagnostic criteria of Post traumatic stress disorder (PTSD)..
(Psychology World)
3. PTSD I: Describing and diagnosing post-traumatic stress disorder
(The University of Melbourne)
4. Clinician-Administered PTSD Scale for DSM-5: Introduction (Part 01)
5. VA PTSD Criteria and How VA Rates PTSD!
(Hill and Ponton, P.A.)
6. Michelle Bovin - PTSD in the DSM-V
(APA Division 56 - Trauma Psychology)
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