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 16, 2023.

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

Comments (139)

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.

Its very interested readings trauma

I meet all criteria for PTSD but none of the specifications, is that normal? Will it still lead to a complete diagnosis for PTSD?

I am a social work student, but don't have a perfect understanding of course. I believe that the specification would be in addition to a PTSD diagnosis. Not meeting the criteria for a specification should not interfere with your ability to be diagnosed with PTSD.

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. The DSM-5 divides PTSD symptoms into four categories ; 3. These symptoms are associated with traumatic event. Each of the four categories include a group of related symptoms. PTSD is defined as an anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress, such as military combat, violent assault, natural disaster, or other life-threatening events. Having cancer could also lead to PTSD. The top five signs of ptsd are a life- threatening event. This includes a perceived to be life threatening event. Internal reminders of a traumatic event. These signs of traumatic typically present as nightmares or flashbacks. Avoidance of external reminders, altered anxiety state, changes in mood or thinking.

Since the age of four, my stepmom has verbally abused me, and hit me a few times. I have GAD because of this, and I fit the criteria perfectly. I'm only 13 so i don't think anyone would listen, but whenever i get flashbacks, they send me spiraling down into a hole and i don't know what to do. I get verbally abused by my parents, but my stepmom does it worse, and everyone yells at me when I have a panic attack which makes it worse. My dad doesn't care, he manipulated and gaslighted me, and i am not going back for a few months. I have plotted how to kill them, and had to go to a mental institution to get evaluated. My stepdad gets mad when I have a panic attack, and everyone except my therapist acts like it's stupid and overdramatic. I don't want to be broken and i don't know what to do.

I am so sorry you are going through this

describe the category of psychological disorders under which PTSD is classified

interesting, i must be old school. had a rough childhood, took many beatings, alcoholic father who regaularly gave us all a hiding, sexually abused my an uncle when I was 4-ish?, had a cousin who was also abused but he kille dhimself when he wa 20... shame... then onto boarding shcool where I was again beaten regularly (daily?) Then onto the military to go kill some terrorists. I realise now (50) that MAYBE i'm a bit messed up and me regularly wanting to kill someone is MAYBE not normal. I check all 5 of the above criterion, BIG TIME. and here I was thinking that I'm OK.. wow.

There is a higher prevalence of trauma prior to joining the military for those of us who serve. Certainly was for me. This also puts us at higher risk for PTSD while in the military. You might be rated by the VA for PTSD if you haven’t already. Best of luck.

So Sorry to hear that. You might want to look into Complex PTSD (CPTSD) It is a varient of PTSD where one is subjected to abuse, be it physical, emotional and/or sexual, over a period of time in an environment that they can't escape, such as a child at home. There is a subreddit devoted to it on reddit and in the sidebar there are many resources.
I hope that you can find some relief.

I second the r/CPTSD subreddit. I've found that a very helpful community as I, too, am recently exploring this content for myself (after many years of thinking I was fine and my childhood was "good"). I also highly recommend the book "The Body Keeps the Score"- I'm listening to an audio version right now and it is so packed with insight and relatable experiences.

I am 16 and think I might be suffering PTSD from childhood emotional abuse and adolecent sexual abuse. How do I bring this up with my therapist?

I'm a psychologist. You can take a deep breath and tell your therapist or you can put your thoughts in writing and either read them to the therapist, have the therapist read them while you are present, or even give them to the therapist between appointments so you can be prepared to discuss these issues after you know your therapist has already become away of these difficult things from your history. You survived some hard stuff in your past. You don't have to hold those things alone in your head anymore.
Good Luck!

Yes, you must. Go ask help.

Most therapists these days are ready to hear and counsel responsibly in this area. A simple inquiry not unlike what you just wrote might be ideal: “ I have experienced some emotional and sexual abuse and think I may have PTSD. Are you comfortable helping me in this area?”

It depends on you and your therapist. You could say just this, that you believe you may have PTSD. Or you can tell them your symptoms - what is troubling you and which is troubling you most.

During a consult with Compensation and Pension for my benefits increase I was labeled as PTSD! It seems as though everything is a mental illness when you explain your combat experience, but PTS (POST traumatic stress) describes events that I have experienced in life as well as combat. PTSD is a disorder that involves a mental illness which causes problems in the patient’s civilian life! The “fight or flight” condition that the body or brain deals with is normal as it subsides less than a month, where as with PTSD the mind constantly reflects the incident. PTS is considered normal which is not a mental illness.

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.

You can have PTSD for the rest of your life. It would be a good idea for you to talk to a professional about your concerns.

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.

I certainly hope you found one.

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..

Johnny that is a lot of stress on one person, try first with a doctor or emergency VAC #, this is a lot, break it away in bits, it will take time, you came out the other side of trauma, that in itself is amazing. Now find the support to help yourself heal.

Another thought in addition to the first comment on your post, since you have spent time in the USMC, you likely can receive care through a local VA hospital. I know it isn't always available where everyone lives, but it is worth a shot to at least try to get care through virtual therapy or even community music therapy.

Hi there,

I am not sure which state you reside in but below is a resource for you to start looking to get some professional help. The good thing about PTSD is, with meds and therapy a lot of what you are holding on will disappear or you will have tools to manage it. I know you find the right help to give you the relief you so deserve. Best of Luck


Hi Johnny, I’m so very sorry for all that trauma you’ve had to endure. Your stronger than you realize and certainly don’t sound like a retard. You will need to call the number on the back of your insurance card and find a good counselor and psychiatrist. If you see a counselor and you don’t click as for a different one. I had to do that a few times. You said you wanted to be tough guy by joining USMC but you are tough! (Thank you for your service) but look Your still here!! You realize what you’ve been put through but remember that’s not you or who YOU are!! Past behavior doesn’t define future behavior so remember that. It’s time you focus on you and enjoying life not living in the past and let me tell you I get it! Therapy is tough and you’ll cry a lot but it’s a good thing to get it all out like you did in your post. That’s super brave and actually very mature! Go for nature walks and eat good. I honestly had to stop drinking as it made everything much worse for me.I do realize this post was last year but I needed to write you. Please give a follow up if you can. Lots of love and light to you!

Johnny, you sure have been seriously traumatized. I am amazed by your story. I am amazed you were able to write some of it down. I think that is a sign that you are realizing the depth of influence this has had on your life, and have become receptive to reaching out for serious help. It shows me you are brave, that you want to get better, and you believe you can. I am very impressed with what you have written down. I feel you are already on the right track, and I'm wishing you all the very best.

Hang in there. You are survivor. Get solid help. Not wacky friends who think they know stuff. Surround yourself with gentle quiet people, reduce loud noise exposure, listen to gentle music, get in nature, laugh for no reason as long and hard as you can, watch funny movies. Eat healthy , lots of good green veges. Drink plenty of water, get good sleep, reduce blue light exposure. Go for long walks and say to yourself as you do...I am a survivor, I am a good person, I have got this, I am lovable. You have got !this.

Hi, you must look for a psychologist in your country. Try looking for contact informations in google. Hope you get well!

You don't sound retarded, you sound traumatized. Here are a couple of numbers to help you get started on finding the care you need and deserve.

SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.


During this difficult time, the NAMI HelpLine is here for you. HelpLine volunteers are working to answer questions, offer support and provide practical next steps. The resources on this page provide information to address many needs and concerns.

Let’s stay connected, chat, call or email the NAMI HelpLine today.

The NAMI HelpLine can be reached Monday through Friday, 10 a.m.–8 p.m., ET.
1-800-950-NAMI (6264) or info@nami.org

Wishing you all the best.

Hello, I may sound like a nut case, but what helped me with my trauma was to follow a relationship with Jesus Christ. If you are not a religious man yourself, give it a go and may god bless you. Finding a community to help connect with can really help too.

Excellent suggestion, Anonymous. I have PTSD and tried many therapies. They did provide relief but did not completely heal me as there was still this part of me that was wounded and questioning Why Me? Being honest with the Lord, and understanding who He is, completely saved my life - now and for the future - I have a different perspective that has helped me find purpose as I found a true relationship with Jesus.

You are not a nut case! God has you covered!

If you’re ever at that point, things aren’t making sense or you’re concerned about somebody getting hurt or hurting yourself, that requires a 911, baby. No joke. Get to the ambulance or ER as quickly as possible and you tell them you’re worried about yourself and need to be evaluated ASAP. Many many hospitals have mental health services, classes, even overnight programs to help get things sorted out where are you. But it sounds like you’re at a place in life where you definitely need to reach out for outside, licensed, trained professionals - I have friends that have done this both ways. One drove herself straight to the ER EMERGENCY at the hospital ; they kept her there for observation overnight and then she was moved to the dedicated behavioral health area of the hospital where she worked with specialists, trained therapists, group therapy, art, medical doctors and nurses. She came out with a PLAN! She was there somewhere around a week maybe. I don’t remember exactly. And then she had follow up group coaching and group sharing and group therapy classes that she attended for some weeks after leaving and now she’s with her own therapist and doing better. Another family acquaintance was taken to a behavioral center by a family member that was worried about them. You just go to the front desk and tell them while you’re there. That you are afraid of doing something you shouldn’t or that you’re afraid to can’t tell what’s real or don’t trust yourself. Whatever it is, let the people at the front desk now. Hopefully the person that brought you to the medical facility will be able to help you with the paperwork because it could be pretty emotional. But once the admission and getting your room is finished, things seem to quiet down and you will find a person or two that you relate to. Doctors are on call and on staff in those facilities to help listening to your history and how you were feeling and start a medicinal regimen that will hopefully be a healthy one for you. Sometimes they may have to adjust the levels depending on what kind of medicine you need but it’s OK because you’re in a safe environment while they are doing it surrounded by medical professionals so that’s the good thing about that. Either way, I hope you will take yourself or a friend or family member will take you to a nice behavioral health center/hospital. You are not alone In your struggle. Your struggle is real and there are plenty others out there who are feeling like you as well. You are not alone. These programs really help put things in perspective. So if you can find nowhere to go and you’re concerned about yourself or anyone around you I say dial 911. You could save their life or the life of others. That’s worth a 3digit call, right ? ABSOLUTELY!!!

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?

Depersonalization and Derealization are common symptoms of PTSD. There is no diagnosis for just Depersonalization/Derealization as they are symptoms not a complete disorder. It can be a common symptom of Depression just as with PTSD. Just because you have Depersonalization/Derealization does not mean you have PTSD or Depression though. It matters the context in which it appears and an individual's case. For example a person may begin to experience dissociative symptoms in the context of triggers for their trauma and then it would likely be conceptualized as a symptom of PTSD whereas a person who dissociates when they feel hopeless may mean it will be conceptualized more as a symptom of depression. One of the things I have learned from my classes on PTSD is that the majority of people who experience PTSD also have a co-occurring mood disorder as well such as depression which means both the cases above may be true.

It's my understanding that Depersonalization and Derealization can be a symptom of other anxiety disorders that don't meet the criteria for PTSD.

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