Posttraumatic Stress Disorder
(see also www.dsm5.org)
A. The person was exposed to one or more of the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways: **
Experiencing the event(s) him/herself
- Witnessing, in person, the event(s) as they occurred to others
- Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental
- Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
B. Intrusion symptoms that are associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by 1 or more of the following:
- Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or affect of the dream is related to the event(s). Note: In children, there may be frightening dreams without recognizable content. ***
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
- Marked physiological reactions to reminders of the traumatic event(s)
C. Persistent avoidance of stimuli associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by efforts to avoid 1 or more of the following:
- Avoids internal reminders (thoughts, feelings, or physical sensations) that arouse recollections of the traumatic event(s)
- Avoids external reminders (people, places, conversations, activities, objects, situations) that arouse recollections of the traumatic event(s).
D. Negative alterations in cognitions and mood that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:****
- Inability to remember an important aspect of the traumatic event(s) (typically dissociative amnesia; not due to head injury, alcohol, or drugs).
- Persistent and exaggerated negative expectations about one’s self, others, or the world (e.g., “I am bad,” “no one can be trusted,” “I’ve lost my soul forever,” “my whole nervous system is permanently ruined,” "the world is completely dangerous").
- Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
- Pervasive negative emotional state -- for example: fear, horror, anger, guilt, or shame
- Markedly diminished interest or participation in significant activities.
- Feeling of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)
E. Alterations in arousal and reactivity that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:****
- Irritable or aggressive behavior
- Reckless or self-destructive behavior
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance -- for example, difficulty falling or staying asleep, or restless sleep.
F. Duration of the disturbance (symptoms in Criteria B, C, D and E) is more than one month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not due to the direct physiological effects of a substance (e.g., medication or alcohol) or a general medical condition (e.g., traumatic brain injury, coma).
With Delayed Onset:if diagnostic threshold is not exceeded until 6 months or more after the event(s) (although onset of some symptoms may occur sooner than this).
* Developmental manifestions of PTSD are still being developed. The term 'developmental manifestation' in DSM-V refers to age-specific expressions of one or another criteria that is used to make a diagnosis across age groups.
** For children, inclusion of loss of a parent or other attachment figure is being considered.
*** An alternative is to retain the DSM-IV criterion
**** The optimal number of required symptoms for both adults and children will be further examined with empirical data