PTSD Symptoms & Criteria
According to the Diagnostic and Statistical Manual (DSM) V.
The following list of general symptoms outlined in the DSM V is the official list of what PTSD looks like in terms of clinical diagnostic criteria. If you recognize yourself in this list, or if you recognize the reflection of someone you love, it’s time to get some professional help.
Our free radio show archives feature experts discussing many aspects of PTSD and its symptomology, plus what it takes to heal.
The journey to healing begins with recognizing the problem. Here it is, plain and simple:
In the immediate aftermath of trauma – say, the first month or so – many people suffer from Acute Stress, which includes the following symptoms:
- Behavioral disturbances
- Avoidance of memories related to the trauma
All of these symptoms are part of the normal steps of how trauma survivors process the recent event. However, if these symptoms persist for more than one month (and begin to functionally and socially impair – and significantly upset - the survivor), then the diagnosis is changed to Post-Traumatic Stress Disorder. According to the DSM-IV Classification this means the subject meets the following six criteria:
A. The person has been exposed to a traumatic event in which both of the following were present:
1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2. the person’s response involved intense fear, helplessness, or horror.
1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
2. recurrent distressing dreams of the event
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 on awakening or when intoxicated)
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) 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
6. restricted range of affect (e.g., unable to have loving feelings)
7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Negative alterations in cognition and mood associated with the traumatic event(s) as indicated by two (or more) of the following:
1. inability to remember an important aspect of the trauma
2. persistent and exaggerated negative beliefs or expectations of yourself, others
3. distorted thoughts about the traumatic event that lead you to blame yourself or others
4. persistent negative emotional state
5. diminished participation and interest in significant activities
6. feelings of detachment or estrangement from self and others
7. persistent inability to feel positive emotions
E. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
5. exaggerated startle response
F. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not caused by the physiological effects of substances or another medical condition.
The above symptoms apply to all types of PTSD. However, with further classifications come added delineations:
Complex-PTSD. The first requirement for this diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:
Alterations in emotional regulation. This may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger
Alterations in consciousness. This includes things such as as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body
Changes in self-perception. This may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings
Alterations in the perception of the perpetrator. For example; attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge.
Alterations in relations with others. Variations in personal relations including isolation, distrust, or a repeated search for a rescuer
Changes in one’s system of meanings. This may include a loss of sustaining faith or a sense of hopelessness and despair
Combat PTSD. Following deployment in a war zone, many veterans return home significantly altered. They have a changed view of themselves and the world around them. For some, reactions to their experiences may be short-lived (perhaps lasting the first few months of reintegration back into civilian life). For others, healing may require long-term vigilance and care (lasting months, years and even decades).
- Survivor guilt
- Negative self-image
- Problems with intimacy
- Suicidal feelings
- Preoccupation with thoughts of the enemy
- Revenge fantasies
- Thinking that feelings are meaningless
- Feeling powerless or hopeless
- Resignation (“don’t care”)
Children, Teens & PTSD
(reprinted from the National Center of PTSD)
What does PTSD look like in children?
Researchers and clinicians are beginning to recognize that PTSD may not present itself in children the same way it does in adults. Criteria for PTSD now include age-specific features for some symptoms.
Very Young Children
Very young children may present with few PTSD symptoms. This may be because eight of the PTSD symptoms require a verbal description of one’s feelings and experiences. Instead, young children may report more generalized fears such as stranger or separation anxiety, avoidance of situations that may or may not be related to the trauma, sleep disturbances, and a preoccupation with words or symbols that may or may not be related to the trauma. These children may also display posttraumatic play in which they repeat themes of the trauma. In addition, children may lose an acquired developmental skill (such as toilet training) as a result of experiencing a traumatic event.
Elementary school-aged children
Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trauma. However, they do experience “time skew” and “omen formation,” which are not typically seen in adults. Time skew refers to a child mis-sequencing trauma related events when recalling the memory. Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas. School-aged children also reportedly exhibit posttraumatic play or reenactment of the trauma in play, drawings, or verbalizations. Posttraumatic play is different from reenactment in that posttraumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety. An example of posttraumatic play is an increase in shooting games after exposure to a school shooting. Posttraumatic reenactment, on the other hand, is more flexible and involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).
Adolescents and Teens
PTSD in adolescents may begin to more closely resemble PTSD in adults. However, there are a few features that have been shown to differ. As discussed above, children may engage in traumatic play following a trauma. Adolescents are more likely to engage in traumatic reenactment, in which they incorporate aspects of the trauma into their daily lives. In addition, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors.
PTSD and Traumatic Brain Injury (TBI) often co-occur. Need info on TBI symptoms? Click here.
(Photos: H. Kopp Delaney, Danete, Kipourax (very busy these days), A.K. Nacer, Birdlike, job_earth)