Diagnostic and Statistical Manual of Mental Disorders (DSM – V)
- has defined traumatic event(s) required for diagnosis of PTSD:
- exposure to actual or threatened death, serious injury, or sexual violation, in one or more of the following ways:
- direct experiencing the traumatic event(s)
- witnessing traumatic event(s) in others
- learning that traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or unintentional
- experiencing repeated or extreme exposure to aversive details of the traumatic event(s) e.g. - first responders collecting human remains; police officers repeatedly exposed to details of child abuse
- this does not apply to exposures through electronic media, television, movies, or pictures, unless this exposure is work related
- diagnosis of PTSD can be made when a patient displays an impaired ability to function normally for a period of one month
- delayed presentation, in some instances years after the traumatic event, is common and in these patients the effects are severe
- symptoms required for diagnosis include:
- intrusion symptoms
- recurrent, involuntary and intrusive distressing memories
- recurrent distressing dreams (content and/or affect related)
- dissociative reaction (acting or feeling as if event is recurring)
- intense or prolonged psychological distress to cues
- noticeable physiological reactions to cues
- avoidance
- avoidance or efforts to avoid distressing thoughts or feelings about or closely associated with the trauma
- avoidance or efforts to avoid external reminders (people, places, conversations, activities, objects, situations)
- negative alterations in cognitions and mood
- inability to remember an important aspect (typically due to dissociative amnesia)
- persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (for example, “I am bad,” “No one can be trusted,” “The world is completely dangerous”)
- persistent, distorted cognitions about the cause or consequences that lead to self blame or the blame of others
- persistent negative emotional state (for example, fear, horror, anger, guilt, shame)
- noticeably diminished interest or participation in important activities
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions (for example, happiness, satisfaction, love)
- alterations in arousal and reactivity
- irritable behaviour and angry outbursts (with little or no provocation)
- reckless or self destructive behaviour
- hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance
The World Health Organization classification ICD-11 defines PTSD as follows:
Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following:
- re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. Re-experiencing may occur via one or multiple sensory modalities and is typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations.
- avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event(s).
- persistent perceptions of heightened current threat - for example, as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises.
The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Reference:
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
- International Classification of Diseases 11th Revision; World Health Organization, 2019/2021