The Requirements for a Post-Traumatic Stress Disorder Diagnosis

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How is a Post-Traumatic Stress Disorder (PTSD) diagnosis made? Not everyone who has experienced a traumatic event also has PTSD. Many people experience traumatic events during their life. After a traumatic event, it is normal to have strong feelings of anxiety, sadness, or stress. Some people may even experience some PTSD symptoms such as nightmares, memories about the event, or problems sleeping at night.

However, while you may be experiencing symptoms of PTSD, you do not necessarily have PTSD. Think of it this way: Headaches can be a symptom of a bigger problem, such as the flu. However, having a headache does not necessarily mean that you have the flu. The same is true for PTSD. Many of the symptoms of PTSD are part of the body's normal response to stress.

For this reason, mental health professionals have come up with specific requirements that must be met to get a diagnosis of PTSD. These requirements are referred to as Criteria A - H and are outlined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The six criteria for a PTSD diagnosis are described below. If you have not already done so, you should first learn the basics of PTSD.

Criterion A: Stressor

Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence in one or more of the following ways:

1. Direct exposure to the traumatic event.

2.Witnessing, in person, the traumatic event.

3.Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.

4.Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse).

This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: Intrusion symptoms

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

  • Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
  • Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
  • Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
  • Intense or prolonged distress after exposure to traumatic reminders.
  • Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: Avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event as evidenced by one or both of the following:

  • Trauma-related thoughts or feelings.
  • Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

    Criterion D: Negative alterations in cognitions and mood

    Negative alterations in cognitions and mood that began or worsened after the traumatic event as evidenced by two or more of the following:

    • Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).
    • Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").
    • Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
    • Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
    • Markedly diminished interest in (pre-traumatic) significant activities.
    • Feeling alienated from others (e.g., detachment or estrangement).
    • Constricted affect: persistent inability to experience positive emotions.

    Criterion E: Alterations in arousal and reactivity

    Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event as evidenced by two or more of the following:

    1. Irritable or aggressive behavior
    2. Self-destructive or reckless behavior
    3. Hypervigilance
    4. Exaggerated startle response
    5. Problems in concentration
    6. Sleep disturbance

    Criterion F: Duration

    Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.

    Criterion G: Functional significance

    Significant symptom-related distress or functional impairment (e.g., social, occupational).

    Criterion H: Exclusion

    Disturbance is not due to medication, substance use, or other illness.

    Making the Diagnosis

    If you think you may have PTSD, it is important that you meet with a mental health professional trained in assessing and treating PTSD.

    Types of PTSD Treatment Providers

    To determine whether or not you have PTSD, the clinician will interview you. The clinician will ask about all of the above symptoms, and he will determine whether or not they are being experienced strongly enough to be considered a problem.

    Being Diagnosed with PTSD: What to Expect

    In addition to PTSD, your treatment provider may also ask you about other psychological conditions often found to co-occur with PTSD, including major depression, substance use disorders, eating disorders, or anxiety disorders.

    PTSD can be a difficult illness to cope with. Yet, there is hope. We are learning more and more about PTSD everyday, and a number of treatment options are available. You can learn more about treatments for PTSD through the following articles:

    Cognitive-Behavioral Treatments for PTSD

    Cognitive-Behavioral Treatments (or CBT) for PTSD focus on changing the way in which people evaluate and respond to situations, thoughts, and feelings, as well as unhealthy behaviors that stem from thoughts and feelings.

    Exposure Therapy for PTSD

    Exposure therapy is a behavioral treatment for PTSD that aims to reduce a person's fear, anxiety, and avoidance behavior by having a person fully confront (or be exposed to) thoughts, feelings, or situations that are feared.

    Acceptance and Commitment Therapy

    Acceptance and Commitment Therapy is a behavioral treatment that is based in the idea that our suffering comes not from the experience of emotional pain, but from our attempted avoidance of that pain. Its overarching goal is to help people be open to and willing to have their inner experiences while focusing attention not on trying to escape or avoid pain (because this is impossible to do) but instead, on living a meaningful life.

    Treatments for the Co-Occurrence of PTSD and Substance Abuse

    PTSD and substance abuse frequently co-occur, and therefore, several treatments have been developed that specifically target this co-occurrence. Seeking Safety is one such treatment.

    Psychodynamic Psychotherapy for PTSD

    Psychodynamic psychotherapy focuses on numerous factors that may influence or cause a person's symptoms, such as early childhood experiences, current relationships and the things people do to protect themselves from upsetting thoughts and feelings. Unlike CBT, psychodynamic psychotherapy emphasizes the role of the unconscious mind in our behaviors.

    You can find PTSD treatment providers in your area through UCompare HealthCare from About.com, as well as the Anxiety Disorder Association of America.

    Source:

    American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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