DSM-5 Criteria for Posttraumatic Stress Disorder

Exposure

Exposure to actual or threatened death, serious injury, or sexual violence in ≥1 of the following ways (may be multiple events):

Directly experiencing the event

Witnessing the event in person as it occurred to others

Learning that the traumatic event occurred to a close family member/close friend; if actual/threatened death of a family member or friend, event must have been violent or accidental

Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g. first responders collecting human remains or police officers repeatedly exposed to details of child abuse); does not apply to exposure through electronic media, TV, movies, or pictures, unless this exposure is work related

Intrusion symptoms

≥1 of the following associated with the traumatic event, beginning after the traumatic event occurred:

Recurrent, involuntary, and intrusive distressing memories of the traumatic event; in children, repetitive play may occur where themes/aspects of the traumatic event are expressed

Recurrent distressing dreams where content and/or affect of dream are related to the traumatic event; in children, there may be frightening dreams without recognizable content

Dissociative reactions, e.g. flashbacks, where individual feels or acts as if the traumatic event were recurring; may occur on a continuum, with the most extreme expression being complete loss of awareness of present surroundings; in children, trauma-specific reenactment may occur in play

Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

Avoidance

Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by ≥1 of the following:

Avoidance of (or efforts to avoid) distressing memories, thoughts, or feelings about or closely associated with the traumatic event

Avoidance of (or efforts to avoid) external reminders (e.g. people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event

Altered mood

Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by ≥2 of the following:

Inability to remember an important aspect of the traumatic event

Typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs

Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world

e.g. “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”

Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others

Persistent negative emotional state

e.g. fear, horror, anger, guilt, or shame

Markedly diminished interest or participation in significant activities

Feelings of detachment or estrangement from others

Persistent inability to experience positive emotions

e.g. happiness, satisfaction, or loving feelings

Altered reactivity

Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by ≥2 of the following:

Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects

Reckless or self-destructive behavior

Hypervigilance

Exaggerated startle response

Problems with concentration

Sleep disturbance

e.g. difficulty falling or staying asleep or restless sleep

Additional required criteria

Must have all 3, plus criteria above

Duration of the disturbance is >1 month

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

The disturbance is not attributable to the physiological effects of a substance (e.g. medication, alcohol) or another medical condition

Calc Function

DSM-5 Criteria for Posttraumatic Stress Disorder