In 2000, the American Psychiatric Association revised the PTSD
diagnostic criteria in the fourth edition of its Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR). The
diagnostic criteria (Criterion A-F) are specified below.
Diagnostic criteria for PTSD include a history of exposure to
a traumatic event meeting two criteria and symptoms from each of
three symptom clusters: intrusive recollections, avoidant/numbing
symptoms, and hyper-arousal symptoms. A fifth criterion concerns
duration of symptoms and a sixth assesses functioning.
Criterion A: stressor
The person has been exposed to a traumatic event in which both
of the following have been present:
1. The person has experienced, witnessed, or been
confronted with an event or events that involve actual or
threatened death or serious injury, or a threat to the physical
integrity of oneself or others.
2. The person's response involved intense fear,
helplessness, or horror. Note: in children, it may be expressed
instead by disorganized or agitated behavior.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least
one of the following ways:
1. Recurrent and intrusive distressing recollections of
the event, including images, thoughts, or perceptions. Note: in
young children, repetitive play may occur in which themes or
aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note: in
children, there may be frightening dreams without recognizable
content
3. Acting or feeling as if the traumatic event were
recurring (includes a sense of reliving the experience,
illusions, hallucinations, and dissociative flashback episodes,
including those that occur upon awakening or when intoxicated).
Note: in children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to
internal or external cues that symbolize or resemble an aspect of
the traumatic event.
5. Physiologic reactivity upon exposure to internal or
external cues that symbolize or resemble an aspect of the
traumatic event
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness (not present before the
trauma), as indicated by at least
three of the following:
1. Efforts to avoid thoughts, feelings, or conversations
associated with the trauma
2. Efforts to avoid activities, places, or people that
arouse recollections of the trauma
3. Inability to recall an important aspect of the
trauma
4. Markedly diminished interest or participation in
significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have
loving feelings)
7. Sense of foreshortened future (e.g., does not expect
to have a career, marriage, children, or a normal life span)
Criterion D: hyper-arousal
Persistent symptoms of increasing arousal (not present before
the trauma), 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
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more
than one month.
Criterion F: functional significance
The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Specify if:
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
Specify if:
With or Without delay onset: Onset of symptoms at least six months
after the stressor
References
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders DSM-IV-TR ( Fourth ed.).
Washington D.C.: American Psychiatric Association.
