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 (102)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I totaled my car alone on an interstate going 80mph when I was 19. I had broken bones in my arm and back but no idea as I ran from my car. My family drove 4 hours to the hospital I was being treated at. My little sister came. I think about how she must have felt frequently. It's been 3 years since that incident, and I've just read through this criterion and met it all. While my bones have healed I don't think the mental wounds are ready. I wonder how much longer it will be.

Look into EMDR as a treatment, it can be life changing and allow the brain to heal from the trauma.

I was diagnosed PTSD and severe depression. I went to a mental facility. My son was shot in 2014 8times. He did live. Dealing with his anger my anger. I broke. .. my father an alcoholic beat my Mother . Made sexual passes at me at 14, he never touched me. Saying he had sexual feeling a for me. I have faked it too long. I needed a good psychiatrist and meds that suited me.

In 1998 my father shot himself in the head, killed- my brother died 2 weeks to the day drininking as he was guilty, sister killed herself pills and boose and little brother killed himself accidentally taking oxy and alcohol. Was abused as a kid, got kicked out of shool 2 districts for fighting, very angry- joined usmc on 17 th birthday to get out of there, it was very sick, alcohol and drugs- dad taught us how to get drugs and pills and alcohol. i am sick in the head and very anxious and wasnt to get help. I guess I figured out I have PTSD recently. I was trieng to be a tough guy in USMC and infantry - wodering where to start. I dont want to be sick. Its just been too much. I cant work, I am finding myself not being able to talk and answer questions. i sound retarded. Its just enough. where do I go to start to get help confidentially..

There are plenty of services that can work with you. There are low cost and sliding scale centers, and universities have training facilities for people getting their license to be therapists. Please get help. You can have a happier life.

I'm so sorry to hear what you have been through. This organization is doing cutting-edge research on PTSD and results thus far are pretty promising. https://maps.org/whatisptsd

I'm so sorry that you experienced all of that, wow that is so much to have to go through. It sounds like you tried to battle all of those emotions and trauma on your own for too long. I'm so glad you got the help that you needed. I hope that you will be able to process all of your feelings, you are strong and learning to ask for help is part of your strength. Be well.

What is the difference primarily between a diagnosis of PTSD with DPDR subtype and DPDR by itself?

What would you say is the main difference between PTSD and vicarious trauma (VT)? After the inclusion of indirect exposure to PTSD definition, what we could say their main difference is? Permanent changes in cognition?

Writing a story about a person with PTSD to shed some light on it, and since I want to get into psychology. Would my character be able to be diagnosed with PTSD a month after the accident?

Yes, 1-month is the minimum. Prior to 1 month it is Acute Stress Disorder

They can be diagnosed after 1 month as this article explains the Sx must last for 1 month. Less than 1 month would be acute.

No. “Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.”

That is for the specifier not the diagnosis.

This applies only for PTSD with a delayed specification. One can experience and be diagnosed with PTSD before six months. If diagnostic criteria do not appear before six months, it is considered delayed.

No, not necessarily, especially in the case of childhood victims of repeated sexual assault, more so in their younger years when they repress memories and it may take a severe triggering event to allow these memories to resurface.

It can take years for these memories to resurface in full, decades even. However the patient may be completely unaware that their current behaviour and emotional responses are a direct result of severe trauma in their young years

I can completely say that this is the case for me. I somehow suppressed the memory for about 5 to 6 years after being sexually assaulted for about 3 years starting around the age of 6. For the past 4 years after remembering what happened, I have become severely anxious in the safest circumstances and had anxiety attacks that have progressively gotten worse and can now be considered panic attacks. It is very hard to cope that past event from suppressing those memories and remembering the reality of what happened years later.

hi guys :). I am looking for help for me and my girl. i am from France

Check ISTSS.org for info about evidence-based treatments and how to find care.

If you haven't yet found what you are looking for, please respond to me. I am a hypnotheraist, and I work in Toulouse.
Eric Mongnot

i am from Italy hello. Can you help me translate? /rardor

so I really don't know If I have PTSD. I suffered from intense bullying, verbal rejection by all my peers from 8-10 years old and then was ghosted by my 2 best friends at 11 years old. I meet all the criteria. But somehow I keep thinking that maybe the problem should be more intense. When I was a kid, I would cry because I did not want to go to school, which is where I experienced these horrible events, but my mom would ignore me.
Saying that I was just crying as a form of manipulation. I remember that she only ever listened to me once, when I was already 11 years old. We were in the car and I began crying desperately... so she parked and took like 5 minutes and then she dropped me in school anyways.
Anyways... I feel helpless whenever I am rejected and sometimes It takes me a long time to let go of the feelings of rejection.
Then after I explode I feel ashamed
Then after I feel ashamed I step out of my own self like If my body is just an experiment and I look at the problem from the outside.
I also feel like I can't talk about my emotions or feelings freely because my mother would always shame me for those emotions and those moments I wanted to cry. So I hold everything in, until I can't anymore and I explode into tears.
I have relived my trauma sometimes. But not in the exact way, I relive the feeling of abandonement, but I also the feeling of not wanting to tell anyone about what I am going through so I push people away and I lock myself in my room when these things happen.
I feel like it has happened around every 2 years in the past 6 years.
And sometimes dating makes me remember the experience.
But the last thing is that I have a friend and I didn't even want to date him because I thought I would lose him, so I told him that.
But I felt soooo helpless, like I would lose him anyway and I cried so much, even though he didn't ghost me or anything. He was still there for me but at the moment I had this horrible fear of being alone again.
I didn't want to date him, because I don't think I'll ever be good enough and that I have such a troubled mind that I would never be good enough.
I really don't know If I have PTSD.
I am also very sensitive when I am dating, the last 2 guys I dated I made this huge drama because they didn't talk to me for one week. That ended in us breaking up.
I have never had a relationship and I become so shy and self conscious for fear that I won't be good enough.
So I really don't know if it's just self-esteem or it's a combination.
But sometimes I do relive the actual trauma, the feeling that the trauma caused me and I have these flashbacks of the event, like a movie that plays in the back of my head.
I also have sef-harming thoughts....
And I avoid looking at couples
And then I have feelings of denial, like it's not true, he doesn't love me, he just wants me for sex....
I don't know what to believe anymore.

Hi anonymous, I'm not qualified in this area, but I identify as having CPTSD as a result of having a narcissistic mother and family. Narcissism is brutal. You deserved better from your Mum and from your school. You did nothing wrong. People who ignore you for a week and have a go at you about it when you say that's not okay - are worth letting go. You deserve better. Learning to love yourself and getting to where you really know you deserve better is key. Setting boundaries. It's not okay to disrespect you, and yes, if you are in contact with someone many times a week - when they reduce that to once without a why - you have a right to ask. Love yourself... and head to YouTube - there are many videos on Narcissistic survival and recovery. It's insidious. So much coercive control and abuse that is only recently being seen by professionals.

I'd recommend time with self, self awareness, fostering self love and boundaries... get rid of, I mean go no contact with ASAP, anyone that makes you feel less than them - and doesn't seem concerned about it - if they have no respect for you - get them out of your life. Only let people in who will be respectful.

I'm in the process of doing all this. Better everyday for the practice. I wish you well. :) xx

Hello, I am a practicing licensed therapist, with a masters in social work and starting a psychology doctoral program soon and have been working for a good long time. I saw this and wanted to respond in hopes I could help direct you towards an answer that will help you get more sustainable help. Having experienced that must have been incredibly painful. Trauma as a child has a profound and not fully understood impact on human development. When it happens at such a young age, it can drastically alter the course of development. It is entirely possible that these traumas resulted you in you developing what is known as Borderline Personality Disorder. I have worked with many individuals diagnosed with that, and it can be extremely debilitating and hard to treat but certainly possible. It is characterized by emotional instability, fluctuating frequently between intense passion or love, to strong hatred or anger in short periods of time, hypersensitivity to perceived rejection and feelings of emptiness and suicidal thoughts or parasuicidal behavior. It is caused by trauma sustained from abandonment and as a result the individual can have distorted beliefs surrounding in their life surrounding real or imagined abandonment which causes hypersensitivity to rejection (or perceived rejection). I would encourage you to seek consultation and therapy from a psychologist as they would be the most experienced and well training in personality disorders and best qualified with helping you to develop the coping skills needed to live a balanced and healthy life. Hope that helps, be safe and don't give up.

my work accident happened in december 2015, an overhead lamp came lose, swung down and hit me on the head and neck, knocking me to the floor. I have never heard from my bos that he is/was sorry for the accident, i tried to go back to work after the two weeks sick leave i was given , i tried for five months til i could take no more, whiplash too. insurance has denied me twice for compensation, migraines, fog, nightmares, seldom leave the apertment, mood swings, confusion, memory problems

I have a Social Work Master's degree in social work. I doubt Hunter does, though, because anyone who's made it out of a rigorous program knows better than to even suggest diagnoses to someone on the Internet, especially since the practitioner has not personally evaluated her/him/them. In America, social workers are not licensed to diagnose patients/clients -- only medical doctors do.

To the OP, continue to explore your concerns. It sounds like you have genuine difficulties that could benefit from treatment. If your symptoms last for over a month, I hope you seek out a psychiatrist (M.D.) for a proper diagnosis.

One thing to understand about chronic, developmental trauma is that many who suffer also devalue themselves. It is common to believe what happened to them wasn't bad enough or as bad as others' have had it. But that kind of thought is part of the systematic mistreatment. Each person is unique --some are more resilient than others, some have more support than others -- and each has a unique reaction, none more warranted or important than any other. Push passed the comparison and ask for a real doctor to evaluate you. The help you get could change your life forever -- for the positive!

Best to you.

Hi friend, I'm currently a college student and my studies cover a lot of ground with Psychology, Sociology, and Early Childhood Development as well and Trauma and Traumatic stress. I am by no means an expert, but I can tell you that the diagnostic criteria for children with PTSD are completely different from adults or adolescents who experience trauma. Since these situations you experienced happened while you were younger, from a developmental standpoint your brain would have responded very differently. Something that might be beneficial for you to read up on if you're curious is what is called attachment theory, specifically something called attachment injury. Attachment styles are formed within the first two years of life and often stay with us into our adult relationships. Attachment injury is anything that happens along the way that damages how we view and experience relationships. A fear of rejection is a pretty universal human experience, but if it's interfering with your day to day life this much I'd highly recommend seeking out a licensed therapist or counselor in your area, therapy has been super helpful for me in the past. Someone whom you're close to and trust can also be a good option, a close friend, a professional mentor, teacher, a pastor, priest, or other religious leader, whomever you're comfortable unpacking some of this with. Your ability to be vulnerable with yourself and others will be your greatest strength in a lot of ways. Hang in there, I know everyone says this but it really does get better.

Hi, it kind of sounds very much like symptoms of PTSD. Have you thought about seeing a counselor who is trauma informed?

You need to get an evaluation by a trained therapist or psychiatrist. The differential Dx for PTSD is trickier than the lay person thinks.

You have to be careful who diagnoses you. I was told I had PTSD by one psychologist and another said no because I don't remember the event. How could I remember? I was only 8 months old when my dad beat me up. He said, "Babies go through all kinds of things and it doesn't affect them. They're resilient". That made me feel worse! There are a lot of uncaring doctors who seem ignorant to me.

Good luck!

I'm so sorry you are going through this. You are not a mess, you are not broken, this is not an out of the ordinary reaction to what you've went through. Please reach out for professional help, you deserve to feel safe in yourself. Take care x

How do I cite this?

I've been dealing with PTSD for the last 2 years because of 7 years of domestic violence from my ex-partner. I've tried medication, counselling, yoga, and trying to expose myself to the memories by talking about them with trusted people. I'm constantly on edge, can't concentrate, have sleeping issues, and a list of other issues related to the PTSD. How can I heal from this???

i got diagnosed a few days ago and i was like "there's no way." looked this up and. i guess there's a way. i have PTSD from extreme bullying and uh, family stuff. but i don't remember most of it?

That sounds more like C-PTSD than PTSD. (Yes, they’re different.)

Trust me, I get it. I experienced trauma from the age of 5 to around 9 (I am almost 20 now). I never thought there was a way and it took me years to figure out that PTSD could be the reason why I have never felt normal for most of my life.

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

The doctor doesn't rate you, the VA does. If you got a 30% rating, thats pretty good for your first go round. Ask for an increase and think of your most symptomatic day during the exam and report those symptoms

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.

That must have been extremely hard for you - not getting support makes it even worse. I hope things got better for you.

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.

I'm a licensed therapist and PTSD sufferer. The longer I waited, the worse it got. I now have seizures, am on disability, and leave the house maybe twice per month. Go to a mental health professional who is CONNECTED with a psychiatrist. Do your homework. Find a good clinic and take back your life, baby!

The best thing you can do is to talk to a professional who has experience and tools for helping people heal from trauma!
Good LUCK to you! But, if you get good help, it can be ok.
I suggest that you go straight to the psychologist, or check with your doctor for a possible referral.

You can talk with both, your doctor because this diagnosis can have some physical symptoms, and with a psychiatrist because you have to be treated with therapy, and if the psychiatrist considers, he/she will prescribe you medication.

I too have PTSD. Only if you need a referral to see a psychiatrist do you need to explain "symptoms" that you are having (for example; anxiety, insomnia due to racing thoughts, negative thoughts, low self-esteem, or anything that you feel when being triggered. You do not have to disclose any other information or go into detail until you speak to the psychiatrist. I personally like to see a psychologist vs psychiatrist because a psychiatrist is more about prescribing medicine. They can diagnose you, however, with me I have found a psychologist is more about going a little slower and getting to the root through better testing, getting to know their patient and therapeutic conversation. A psychiatrist will try and diagnose you quickly to figure out which medicine to prescribe and they do not talk yo you or form a relationship with you to the degree of a psychologist. You can also see both. The psychiatrist for medication management. Whatever you talk to either Dr about is personal and confidential. Please seek help to get you on the road to a better future.

I am a combat veteran of OIF and I understand your position about not wanting to tell unnecessary entities about an incredibly personal experience. That is natural and healthy to some extent, but keep in mind the avoidance criteria for PTSD and how that in and of itself keeps many people from ever seeking help in the first place. PTSD is primarily the domain of psychology, so if you can find a psychologist or psychiatrist, they will probably both need to help you if you need medication, because psychiatrists dont typically provide psychotherapy or much assessment. I would seek out a clinical psychologist.

Find a therapist who has been working with people who have been traumatized. That can be a Licensed Marriage and Family Therapist, a Licensed Clinical Social Worker, a Clinical Psychologist or another Masters or Ph.D level clinician. Talking about what you went through and working with someone who can help you learn to cope with and understand better the impact of the events that occurred in your life. Depending on the theoretical orientation of their training, they may help you build tools to manage you response to recurrent and intrusive memories, nightmares, avoidant patterns and the powerful emotions evoked by triggers that can re-evoke the memories and emotions, or they may work with EMDR or other tools that can help you work through the trauma. Medical doctors and psychiatrists can prescribe meds to help with sleep, depression and anxiety, but generally don't help people build coping skills needed to work through and beyond the intense phase of PTSD that can last for years for some who only improve with talk therapy. You may have an Employee Assistance Program connected with your employment which can refer you to someone, your insurance coverage should have a listing of therapists, or you could go to your area's Mental Health Services to get help.

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.