PTSD diagnostic criteria
According to the DSM-5, PTSD requires exposure to actual or threatened death, serious injury, or sexual violence — either directly, as a witness, through learning it happened to someone close, or through repeated exposure to aversive details (as with first responders).
The four symptom clusters
1. Intrusion symptoms
Involuntary, distressing memories; nightmares; flashbacks (dissociative reactions where the person feels the event is happening again); intense psychological distress or physiological reactions to trauma reminders.
2. Avoidance
Persistent efforts to avoid distressing trauma-related thoughts, feelings, or external reminders (places, people, activities, situations).
3. Negative alterations in cognition and mood
Inability to remember important aspects of the trauma; persistent negative beliefs about oneself or the world; distorted blame; persistent fear, horror, anger, guilt, or shame; diminished interest in activities; feeling detached from others; inability to experience positive emotions.
4. Alterations in arousal and reactivity
Irritability or aggression; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; concentration problems; sleep disturbance.
PTSD vs acute stress vs adjustment disorder
Acute Stress Disorder involves similar symptoms but lasts 3 days to 1 month after trauma exposure. PTSD is diagnosed when symptoms persist beyond a month. Adjustment Disorder involves emotional or behavioral symptoms in response to an identifiable stressor, but doesn't involve the intrusion symptoms characteristic of PTSD.
Getting a proper diagnosis
A proper PTSD diagnosis requires a clinical evaluation by a licensed mental health professional. Standardized assessment tools like the PCL-5 are commonly used. A correct diagnosis is essential because the most effective treatments for PTSD differ from those used for other anxiety or mood disorders.