Diagnostic criteria

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

Proposed ICD-11

• criterion defining traumatic event
  • exposure to and extremely threatening or horrific event or series of events
• symptoms required for diagnosis include:
  • intrusion symptoms
    • vivid intrusive memories, flashbacks, or nightmares, typically accompanied by strong and overwhelming emotions such as fear or horror, and strong physical sensations
  • avoidance
    • avoidance of thoughts and memories of the event or events
    • avoidance of activities, situations, or people reminiscent of the event or events
  • negative alterations in cognitions and mood
    • not applicable
  • alterations in arousal and reactivity
    • persistent perceptions of heightened current threat—for example, as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises
  • additional criteria for complex PTSD
    • severe and pervasive problems in affect regulation
    • persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by deep and pervasive feelings of shame, guilt, or failure related to the stressor
    • persistent difficulties in sustaining relationships and in feeling close to others

Reference:

• (1) Bisson JI et al. Post-traumatic stress disorder. BMJ. 2015;351:h6161