Posttraumatic stress disorder (PTSD) Assessment, Diagnosis, Treatment, Course & Outcome

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a lifethreatening event, like combat, a natural disaster, a car accident, or sexual assault. During this kind of event, you may not have any control over what's happening, and you may feel very afraid. Anyone who has gone through something like this can develop PTSD.

It's normal to have upsetting memories, feel on edge, or have trouble sleeping after a traumatic event (also called "trauma"). At first, it may be hard to do daily activities you are used to doing, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months. For some people, PTSD symptoms may start later, or they may come and go over time.

DSM5 Criteria for PTSD

All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A (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 (one required): The traumatic event is persistently reexperienced, 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 (one required): Avoidance of traumarelated stimuli after the trauma, in the following way(s):

Traumarelated thoughts or feelings
Traumarelated reminders



Criterion D (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 (two required): Traumarelated 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 (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (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 traumarelated 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.