DSM-5 Criteria for Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a common mental health condition in veterans who have undergone or witnessed traumatic events while in service. It is so common that VA offers a comprehensive array of therapeutic and support services for veterans, and we’ve written a number of articles on PTSD as well, including on how to receive a rating for it, and how to increase your rating.

PTSD is discussed more in the wider world today, and you may already have a general understanding of what it entails. It is typically understood as emotional distress stemming from involvement in a traumatic event, but there is more to understand regarding its diagnosis. It can be mistaken for a number of other psychological disorders, and it has some critical comorbidities, some of which are highly applicable to veterans.

This is why we’re going to take a step back and look at PTSD from a diagnostic point of view, and review its criteria of causes and symptoms defined by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

If you or a veteran you know are concerned about having PTSD, or would like to know more about its diagnosis and treatment, we encourage you to seek further information online from VA or from your local healthcare provider.

PTSD Criteria in DSM-5 (309.81) (F43.10)

In 2013, APA came out with the fifth edition of its diagnostic manual, DSM-5, in which the diagnostic criteria for PTSD was revised and included under a new category: Trauma- and Stressor-Related Disorders. All of the conditions listed under this classification require exposure to a traumatic or stressful event as a diagnostic criterion.

What follows is a summary of diagnostic criteria A through H for PTSD in adults, adolescents, and children older than 6 years old. All criteria are required for a diagnosis of PTSD to be made:

Criterion A: Exposure to death, threatened death, serious injury, or sexual violence in one (or more) of the following way(s):

• Direct experience of the trauma
• Witnessing firsthand the trauma
• Learning a relative or close friend was exposed to a trauma
• Repeated or extreme exposure to aversive details of trauma, typically experienced by first responders, medics, police officers, etc.

Criterion B: Presence of one (or more) intrusive symptoms associated with the traumatic event(s) after the event(s) occurred:

• Recurrent distressing memories
• Recurring nightmares
• Flashbacks, or disassociative reactions in which the person feels the trauma repeating
• Intense or prolonged psychological distress in the face of reminders
• Physical reactions in the face of reminders

Criterion C: Avoidance of stimuli associated with the trauma, as evidence by one or more of the following:

• Avoidance of distressing memories and thoughts about the trauma
• Avoidance of distressing external reminders of the trauma, like people, places, conversations, and activities

Criterion D: Negative alterations to mood and cognition, as evidenced by two (or more) of the following:

• Inability to remember important aspects of the trauma
• Exaggerated negative thoughts about oneself, others, or the world
• Blaming oneself or others for the trauma
• Persistence negative emotional state, like fear, horror, anger, guilt, or shame
• Diminished interest in activities
• Feelings of detachment or estrangement from others
• Inability to experience positive emotions

Criterion E: Alterations in arousal and reactivity, as evidenced by two or more of the following:

• Irritability and angry outbursts with little or no provocation
• Reckless and self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Difficulty sleeping

Criterion F: Duration of the disturbance is more than 1 month.

Criterion G: The disturbance causes significant distress or impairment in social, occupational, and other important areas of functioning.

Criterion H: Symptoms are not due to medication, substance use, or another medical condition.

Two specifications are part of this diagnostic criteria, too, and are summarized as follows:

Dissociative Specification: In addition to meeting criteria for PTSD, the person experiences high levels of either of the following in reaction to trauma-related stimuli:

• Depersonalization. Experience of being detached from one’s self or body, as if one were in a dream.
• Derealization. Experience of unreality, like the world were unreal, dreamlike, distant, or distorted.

Delayed Specification. Full diagnostic criteria are not met until at least six months after the traumatic event(s), although onset of symptoms may be immediate.

Prevalence of PTSD

Within the general US population, the DSM-5 estimates the projected lifetime risk for PTSD using DSM-4 criteria at age 75 years is 8.7%, though rates are higher for those in professions that increase their exposure to traumatic events, like veterans. It is generally more common in younger adults than older ones, and in females more than males—due to an increased likelihood of exposure to traumatic events. Variations in prevalence exist across ethnic groups, but broadly speaking, PTSD does not discriminate. Any individual exposed to trauma is at risk of developing PTSD, although differences in how the PTSD manifests may be reflected by the individual’s demographic background.

Among the disorders that can be mistaken for PTSD are acute stress disorder, anxiety disorder, obsessive-compulsive disorder (OCD), major depressive disorder, personality disorders, dissociative disorders, and psychotic disorders.

Suicide Risk and Comorbidities

Traumatic events increase a person’s suicide risk, and PTSD is strongly associated with suicidal ideation and suicidal attempts.

PTSD is also linked to other mental disorders. According to DSM-5, those with PTSD are 80% more likely than those without it to have symptoms that meet the diagnostic criteria for at least one other mental disorder, such as depressive, bipolar, anxiety, or substance abuse disorders. Although females are at greater risk of PTSD, males diagnosed with PTSD are more likely to have a comorbidity. Among Afghanistan and Iraq veterans, it’s been found that the co-occurrence of PTSD and a mild traumatic brain injury (TBI) was 48%.

Resources and Assistance with VA Claims

Veterans have played an outsized role in spreading awareness of PTSD, especially following the recent wars in Afghanistan in Iraq. The disorder is better understood now than it ever has been in the past, and because veterans have a higher likelihood of experiencing traumatic events, we encourage any who experience the diagnostic criteria above to seek professional treatment. VA provides extensive services to help veterans cope with this disorder.

Should you have any difficult obtaining the level of treatment you need for PTSD, and need our help to increase your disability rating for PTSD, you can reach us at 844-VET-LAWS or fill out our online form.