DSM-5 Criteria for PTSD

National Center for PTSD, U.S. Department of Veterans Affairs
DSM-IV-TR Criteria for PTSD

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1. PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.

Note that DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger. The criteria below are specific to adults, adolescents, and children older than six years.

All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A: stressor (one required)

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: intrusion symptoms (one required)

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: avoidance (one required)

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

Criterion D: negative alterations in cognitions and mood (two required)

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: alterations in arousal and reactivity

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F: duration (required)

Symptoms last for more than 1 month.

Criterion G: functional significance (required)

Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion (required)

Symptoms are not due to medication, substance use, or other illness.

Two specifications:

  • Dissociative Specification In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
    • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
    • Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").
  • Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

For a review of the DSM-5 changes to the criteria for PTSD, see the American Psychiatric Association website on Posttraumatic Stress Disorder. Full copyrighted criteria are available from the American Psychiatric Association1.

1. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

Posted on BrainLine February 22, 2018. Reviewed March 28, 2019.

From the National Center for PTSD, U.S. Department of Veterans Affairs. www.ptsd.va.gov.

Comments (56)

MST survivor , scored 74 by C&P.
Dr. Rated at 30% for PTSD by V.A., can this be accurate?

I went through all the criteria.

I met the criteria for each one, A-H.

I had a severe gran- mal/tonic-clonic seizure that nearly killed me. Which I had told my (ex)wife, could happen. Her reaction, was to jump off the bed, and run out of the bedroom. That was not very supportive.

She left me two years later with the kids'. I divorced her three years after she left. She said she wished we never had kids. She also wished my (physical)health issues(that started before birth) "would just go away".

I will never forget the day of that seizure.

I am a undiagnosed PTSD sufferer. I feel that it has come time to tell a doctor. Do I need to tell my regular physician or a psychiatrist. I don't want to talk about all these things with a bunch of different people. I just want to talk to the right doctors who need to know and maybe treat me. Please let me know if you can.

You can talk to either physician, though PTSD is fairly involved in treatment, so I would recommend seeking treatment from the psychiatrist, as they will have more time to focus on your individual plan. Best of luck on your road to recovery! I know PTSD is hard to live with, but seeking professional help will work wonders for your wellness, you're making a good first step.

Your psychiatrist(if you want a to seek a medicinal route) and therapist(if you want therapy, some forms such as EMDR therapy are particularly effective for PTSD) will be the ones to help you regain control of your illness. No need at all for a regular physician, unless you need them to refer you to an aforementioned specialist.

PLEASE educate yourself in the Feldenkrais method...it is the derivative of all the theories behind EMDR. BUT it also includes the ENTIRE body not just the eyes. EMDR is the Go To right now because its the only thing therapists are being trained to do to reprogram the brain though movement. YES it works, because the brains optical nerves run straight through the center of the brain into the back of the occipital lobe. your eyes move and stimulate the brain in such a way to create a thought or memory of feeling. the thing about pain and trauma is the nerves keep re-firing if there is a stimulus that is similar to the original trauma, and in some cases the stimulus is not even needed for the firing to happen randomly ( that sucks when that happens)...if we give the nerves a different Pattern to play out when the trauma is re fired, the brain will do that NEW pattern instead, one that is not negative. therefore moving the eyes can reprogram your response. but what I love about Awareness Through Movement and Functional Integration is, we don't just move the eyes, we move the whole self, body and mind. please check it out. Feldenkrais Method, Awareness Though Movement and Functional Integration.

Hi I basically meet all these criteria except possibly A. I was born 1 1/2 lbs and diagnosed with bipulmonary dysphasia. I had a tracheotomy at two weeks and taken out at 18 months. I have a crippling fear of hospitals and always vowed to die rather than have any kind of surgery. Iv had alot of these symptoms my whole life and only recently put two n two together. Since I was an infant and conciously unaware of what was happening, is that inadvertant exposure? In my mind to this day, hospital equals getting cut open and death. Im currently 31. Idk why I have this fear its just there always in the back of my head. Becomes a crippling fear n anxiety when Im faced with a potential medical situation. Can someone develop ptsd as an infant? What can I do to get properly diagnosed and control my anxiety?

There had been EMDR protocol developed for pre-birth as well as infantile trauma. I'd check it out. It's still a controversial field but I've heard that it works for some. Diagnosis is only a tool to get to the solution; if you don't necessarily meet the criteria but want to use the solution, I don't see no problem with it.

Hi. This is actually a super interesting question. Some Dr.s still think that infants have no actual long term damage from the things that happen to them so early in life. its kindof contrary to the belief that a child can develop ptsd as a baby, but as we see here in the DSM 5, there is a whole category fro children under six.
Id suggest checking out Moshe Feldenkrais books and other people who study the neuroscience of trauma and child/infant development. in my studies in that field, I have been lead to decide for myself that, Of course you are affected, maybe even more from those first moments of life than any other experience you ever have. it is the foundation of all of your bio feedback as an adult. even if you have no memory consciously, your body remembers. trauma is the event, PTSD if the event still " living" inside of you, replaying and re-traumatizing you. its a way the brain protects you from further "perceived pain" ...the truth is people have differing views on this topic in the medical field, but YOU know your body and you can tell. Honestly I bring up this point to my teachers, because I have a theory that circumcision in not a good thing for brain development of the baby boys. its just a theory but as you know, you have been affected by what happened to you as a baby, even though you know it was to save your life now, as a baby you didn't know that. and thats why it was so scary. we don't understand infant development all that well, because not long ago ( even now) Drs think babies DONT HAVE FEELINGS. literally. this old school of thought is so wrong. but we still don't understand a lot of things with the brain.
I have PTSD from adult events. I wish you well in your journey, if I were you id go to a person who does believe in your issue and will help you heal it, even if it is though visualizations and meditations. Feldenkrais method could help you a lot, find a local practitioner near you, and tell them the story when you go to see them.

It looks like you might want to read PTSD in children under six, because this is when the trauma began for you.

Welp, I fit... Mine's being treated like an enemy, when I have good intentions. If I tell someone that there is a problem and that I want it fixed, and I get treated as the real problem based on how I worded it, then that will eventually give me flashbacks if that kind of treatment lasts long enough, and I get either depressed or angry. If I can sense something's headed that way, I will desperately try to stop it from doing so. It rarely works.

that sounds like blatant projection onto you, a person who is avoiding being accountable and putting the blame back onto you to avoid any self reflection. I'm so sorry and I hope you know that kind of treatment will drive anyone up the wall, and you are not alone. get way from it if you can, if its your family, I hope you can find a way to charge yourself with self love as best you can. YOU know the truth, don't let them manipulate you

Talk therapy can re-traumatize you, which is harmful. Consider EMDR or brain spotting where you don’t have to talk about what happened to you but your PTSD symptoms get healed and go away

My trauma was a suicide attempt so basically exposed myself to a life threatening event. Have you heard of this before. Does anyone do any research on this

I had a failed suicide attempt 4 years ago, should have worked but by miracle it didn't. however I was left with not only ptsd from 40 years of abuse but now since that an anoxic brain injury. needless to say that it's almost impossible to function some days.

I have been having PTSD due to being involved in a car accident. I have to drive frequently 4 hours to another city to see my doctors. Would this exposure to frequent driving increase my PTSD by exposing me to another car accident?

Being in a car at all could trigger a PTSD flashback and/or a panic attack depending on the severity of the incident. Horn honking, the sound of cars rushing by on a freeway and more can cause anything from a sense of discomfort to an intolerable panic. However, using a vehicle is unavoidable in this day and age. If you're too afraid to drive yourself, I would suggest taking a Lyft or an Uber

So I just had my C&P re-evaluation for my PTSD. I am currently 70 SC for PTSD.
I am looking at my exam on myHealthyVet and I hit every Criterion except for G. It reads;

Critierion G : No response provided

Did the Doc just forget the click a box? Or do I not rate that Criterion and will not be SC for PTSD anymore?

I suffered a tbi in September of 1995, i still blame myself for the injury.

Where do i start, had PTSD i guess for close to 30+ years, just hid it from everyone, and always put others before my needs. However, in my head i believe i am not a worthy case for treatment, i believe others should always go before me, am i too damaged to be repaired, am i wasting my specialists time, am i worthy enough, questions with no answers, misfiring memories, hate, anger, fear, different, only answer is how I feel.

Roger, the trauma is in your Body, thats why talk therapy might seem pointless. your nervous system is shot. you are on empty, you cannot muster up fuel that is not there.
First off you must change the way you word it, you must try to 'fake it' in a way and say you CAN possibly believe you can get better, maybe...
sounds like you tried, to no avail, how frustraiting. its not your fault they cant help you, we are still figuring out how to heal trauma. I think you can heal a lot by being touched, any type of hands on therapy helps, and especially therapy that is geared towards healing trauma. Reiki and Feldenkrais method are super helpful. I wish you well, and YOU ARE valuable, even if you don't see it.

Hi Roger, I read your comment and want to share that you are worthy of treatment. You are not "too damaged" I know this because you are sharing this online. I would urge you to try... try to seek help. Tell someone what you are struggling with so you won't carry the burden of this secret any longer. You are deserving and worthy.

Roger, OMG, You just wrote stuff I can`t seem get out of my mouth. I`ve thought, everything you just wrote. I`m in my 34th yr. with this, coupled with a TBI. What a miserable way to live. I would love to tell the docs exactly how I feel but I can never seem to find the words. {How?}, when I get there and I cant remember why I`m there until 10 or 15 min later. When I`m trying to express a thought and in the middle a sentence I forget what I`m talking about. This sucks, i`m tolerating life, no fun, lost emotions{except for anger}, lost interest in damn near everything. My wife is the only reason I`m still here. if it wasn`t for her I would still be drinking as heavy as I did for 28 yrs., trying to end it all.

I am alive but not living! This is a living Hell!

Please find a therapist that has specific training in trauma. You do not have to live a life of emotional pain. There is hope and the right therapist can help you. EMDR is a type of therapy that has been proven to work with symptoms of PTSD.

Im almost 42,ive bn in therapy since i was 9.talking to a therapist only revisits the trauma..and then you go home to your fam with that dr.built trauma revisit.its more harmful,lost a husband this way.lol.the emdr thing,was idiotic.ive tried it ten times.its a waste of time unless you hava light case of ptsd maybe

Hi, Frank! I just want you to know that I'm praying for you. Hope things are getting better.

Everyone deserves healing. YOU deserve healing. And no one is too damaged. It might be more about what you expect repair to be!

I have experienced a lifetime of abuse by narcissistic people starting with my father and most recently by my wife of 10 years and a coworker. I was not physically threatened or hurt, but the psychological damage is severe. Criterion A doesn't apply to me but I still have a form of PTSD because all of the other ones do apply. Help!

look into childhood trauma, sense your father was abusive. you were exposed to many small events that build up. also you don't need to be diagnosed to know that your body is carrying trauma. movement therapy, dance, reiki, acupuncture and Feldenkrais method are all super helpful. EMDR is a derivative of Feldenkrais method.

I’d have to disagree about you not having criterion A. Your father neglected you , the one person who was suppose to be there. That’s a huge loss. Same with your wife. You may not have had a physical loss like a death, but you have been deceived , and abused. Just validating your experiences.

You may have a form of PTSD called Complex-PTSD or C-PTSD. It isn't officially a diagnosable mental disorder according to the DSM-5, but it is when someone experiences repeated/ongoing abuse/trauma. I encourage you to research C-PTSD as well as seek help from a GP/psychologist/psychiatrist.

Hi Beth, I've been through similar. Have you read up on complex PTSD (C-PTSD)?

I have a grandson in grade school who has been physically and emotionally abused by his father since he has been in diapers. He has been retained by his school in seventh grade and has to repeat that grade, not because he is slow but because he had severe school avoidance. The most recent court order states he does not have to go to his father's but the school will not give him the support he needs and the school avoidance continues. We live in Wisconsin, Waukesha County and we need help making the school understand the situation. Who can help!

A child psychologist, a neuropsychologist and or an educational therapist. Also, an advocate or a county lawyer (if you can't hire a lawyer can advocate for your grandson. Especially now that the courts acknowledge he has been abused, the school should be required to provide services.

Worst comes to worst there are online schools he can recuperate units taking classes online.

Hi neighbor. I live in Muskego. Went through something similar ... in some ways. Just want to say you have a long, difficult road ahead. Mom must ask school for an IEP. That will help, a little. Regardless, this is ugly business ... no putting a good face on it. But in our case the loved one made a great turn-around and is now thriving. Hang in there! NOT YOUR FAULT!!

Hi Joseph,

I strongly recommend that his mother or guardian contact the Human Services department in your grandson's county and request Children's Mental Health case management or another form of case management for children. I work for a county in Minnesota as a social worker and we work around the clock to meet with kids and parents to help you find mental health services and other resources. Not always but often times, social workers can attend school meetings (with parent permission) and help communicate the extent of a child's difficulties to school staff and administrators, and in some cases establish the child's need for special accommodations at school. This is often the case for children who avoid school for various reasons. Hope this helps.

Merry Christmas,

I am only 15 and I was diagnosed with PTSD since I was 12 because I was involved in a drive by with my sister and her and I both have it and we were both put in mental asylums in Michigan. We were in there for about 3 weeks with no social media or anything but did activities to get help with it and went to counseling for about 4 months. PTSD has us going through with insomnia and flashback and many more but I thought i'd share our story.

Pretty much sums up my life! I'm not a veteran, ritualistic abuse.

I receive a disability for PTSD/MST and went in to be seen @ Comp & Pen for an additional service related issue. I also have a eating disorder that I directly associated to the MST I don't recall every having an issue with food until after the 2nd MST happened. Now I am suffering from diabetes and am insulin dependent which I feel is a direct result of the eating disorder using food to cope, stuffing feelings and becoming numb. I was told that none of these things are related and that If I wanted an increase in my current disability rating that I needed to be suicidal. I am currently on my 3rd marriage which is riddled with unrest due to the MST apparently I have difficulty having a healthy sex life and they do not consider that as an issue. My husband and I have been thru marital counseling which actually made things worse...Any suggestions?

An ED will not cause diabetes. "Insulin dependent" is for Type 1 diabetics which is typically diagnosed in children or teens. It is a very different disease than Type 2 diabetes which can be diagnosed at any age and is often linked to weight gain. People often think they are "insulin dependent" when they are Type 2 and prescribed insulin, and that is not the case. Type 2's still make insulin, they are insulin resistant yet treated by flooding the body with more insulin. If you were "insulin dependent" you would have lost a lot of weight leading to diagnosis, and you would literally DIE without insulin because your body would not make any.

If you went to marriage counselling and things are worse, where did you seek this counselling? A qualified professional? If so, I would be following up with that professional to report that things are worse. Usually marriage counsellors give you concrete steps to take and discuss whether or not your marriage can be saved. If you have done all that and things are worse, then in my book the marriage is over.

Try DBT given your history of an eating disorder and PTSD. You can teach yourself DBT if you are really desperate. There is a wealth of information online.

My suggestion is, go to a Naturopathic Doctor (ND), and get yourself straightened out chemically and nutritionally. It is also possible you are suffering from thyroid problems. Many doctors do not do extensive blood work and a ND will. A finger-prick approach, so to speak, blood sampling is not comprehensive enough, and is what most physicians do. Be prepared, though, as it can be expensive because some Medical plans will not cover the much needed blood work. Many states do not recognize NDs but while living in WA I went to one and I believe he saved my PTSD/TBI/Hypothyroid life. I had to move to VA and the care here is way behind the times when it comes to holistic medicine. You are a total being. You may have to grow up and take responsibility for your bad eating habits and educating yourself. Thymex and Thyrosol are 2 non-prescription thyroid supplements you may want to discuss with your physician along with taking D2500/5000, and DHEA for adrenal fatigue - very common with TBI/PSTD. There is help online but you have to be very careful as many are just pushing their supplements. Dr. David Perlmutter's book may be helpful to you; Grain Brain, explains how carbs affect your brain/body. I was in 2 auto accidents within less than a year, the first a head-on with the entire driver side of the car sheared. After being removed from the car, I knew my life had changed forever, and I was very familiar with TBI/PSTD as my son was in an accident many years prior. Undiagnosed diabetes (He had been going to the doctor for years, got very ill in 2009, hospitalized and was told he was Type I and had been for years - never informed of nor treated.for the illness, and 2013 died of a heart attack). So I tell you, be vigligant and pro-active about taking care of you and doing what it takes to heal.

Give EMDR a go

i myself have been diagnosed with PTSD and i have had this diagnosis for a little over 4 years. although i do not have PTSD from service in the military or combat situations such as those who serve our country I empathize and hope that something can be done for those who chose to risk their lives for their country. I am curious however as to where i should look for symptoms on a related topic, Traumatic Brain Injuries (TBI). if anyone could point me in the right direction i would greatly appriciate it. i am writing a paper for a local community college that i am hoping to eventually public publically and get additional support for military vets that are still around. if anyone can help i would greatly appriciate it.

Do you have a TBI? I have scads of anecdotal info, unfortunately.

please look at the site of Peter K Gerlach.

I am deeply sorry about your experiences. If it is not too late you can check every topic of psychopathology in the DSM's 5th Edition (there are some pdf's online) which is the most reliable source compared to internet websites. Take care!

I hate the VA. They put me down for my service, my combat, my problems. I have been seeing them for 7 years at three different VA's. My last therapist tried to take away my service dog. That woman's boss made fun of my service record thinking my secret ops were bullshit. I meet a new psychiatrist this morning. I have PTSD. My dealings with the VA isn't going well. Why are these people so evil? I am just looking for help. It is getting closer to a confrontation. I hope it isnt today.

Try the DAV.

Go talk to your patient advocate

I am so sorry that you are going through this. Thank you so much for your sacrifice and your service. Please know that you are awesome.