Understanding PTSD Diagnosis and Approved Criteria – DSM 5

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PTSD, or Post traumatic stress disorder, is a trauma or stressor related disorder that can not only cause significant distress, but has strict diagnostic requirements. If you think that you or a loved one is struggling with PTSD, take a minute to read through the approved criteria from the latest version of the Diagnostic and Statistic Manual of Mental Disorder (DSM 5) to find out if you qualify for an official diagnosis, what type of PTSD you may have, what sorts of treatments are available (and most recommended), and how to help someone with PTSD.

13–20 minutes

PTSD Diagnosis

There are several components to a PTSD (post traumatic stress disorder) diagnosis. Below are the categories and their individual requirements.

Exposure

You must be exposed to an actual life-threatening situation or be threatened with death, experience serious injury or sexual violence in at least one of the following ways.

You directly experience the traumatic event(s)
You witness (in person) the event(s) in real time
You learn that the traumatic event(s) happened to a close family member or a close friend.
- With a threatened or actual death of a family member or friend, the death must have been violent or accidental.
You experience repeated or extreme exposure to intimate details of the traumatic event(s)
- Common with first responders collecting human remains, or police officers repeatedly exposed to details of extreme abuse

Media (photos, movies, tv, social media) exposure to traumatic event(s) does not qualify unless the exposure is work related.

PTSD Symptoms

PTSD symptoms begin after the traumatic event(s) occur, and of the following, at least one must be present to qualify for a diagnosis.

You experience repeated, involuntary and distressing memories of the traumatic event(s)
You experience repeated distressing dreams that are related to the traumatic event(s)
You experience dissociative episodes like flashbacks where you feel as though the trauma is recurring.
- An extreme of this situation could be where you lose all sense of real time and sense of your current situation or surroundings because you are so overwhelmed by your dissociative episode.
You experience intense or unexpectedly longer lasting episodes of distress when exposed to internal or external cues (triggers) of the traumatic event(s)
You experience a heightened reaction to the cues (triggers)

Avoidance Symptoms of PTSD

Other symptoms of PTSD involve avoiding situations or things that could remind you of the traumatic event(s). For a PTSD diagnosis, you need to present with at least one of the following:

You avoid, or try to avoid, remembering the traumatic event(s) or any thoughts or feelings related to the traumatic event(s).
You avoid, or try to avoid, anything external that causes you distress associated with the traumatic event(s).
- Examples of reminders include: people, places, conversations, activities, objects, or situations.

Mood and Cognitive Symptoms of PTSD

PTSD is commonly associated with mood changes or negative impacts on your cognitive functioning, beginning after the traumatic event(s) or worsening afterwards. For a PTSD diagnosis you need to exhibit at least two of the following:

You may be unable to remember important details of the traumatic event(s). This is not due to a head injury, alcohol or drugs, but is attributed to dissociative amnesia.
You may experience a significant loss of interest in normal activities.
You may feel a loss of connection with others to the point of estrangement.
You may have a harder time experiencing positive emotions like love, happiness, or satisfaction.
You may find yourself unable to shake negative emotions like shame, guilt, fear or horror.
Your negative views or expectations of yourself, others, or the world become magnified.
- Ex: “I am a bad person.”
- Ex: “I can’t trust anyone.”
- Ex: “I will never feel safe again.”
- Ex: “My whole nervous system is completely ruined and can never be fixed.”
- You experience distorted thoughts about what caused the traumatic event(s) or what the consequences are. You may wind up blaming yourself or others for things outside their/your control.

Reactivity Symptoms of PTSD

PTSD causes you to become more reactive after experiencing trauma. You may find yourself more vigilant or reactive in at least two or more of the following ways:

You may have trouble sleeping, with either staying asleep, falling asleep, or generally restless sleep that leads to a feeling of not having received proper rest.
You may feel irritable or have angry outbursts where you express your anger verbally or with physical aggression. Your outbursts require little to no provocation.
You may have trouble concentrating.
You may feel hyper-vigilant and unable to relax.
You may startle easily and your startle response is disproportionate to what startled you.
You may engage in reckless or self-destructive behavior.

PTSD Symptom Duration and Causes

For an official diagnosis of PTSD, you must meet the requirements for the above subtypes of symptoms, and experience them for at least one full month. Your symptoms must cause you a significant amount of distress or impair your functioning socially, occupationally or otherwise. Your symptoms cannot be caused by prescribed medication, alcohol or another medical condition.

Types of PTSD Disorders

There are several types of PTSD. The criteria listed above are for the main PTSD diagnosis. But there are also three other forms of PTSD that you may experience that are also valid forms of PTSD experiences. If you think you are experiencing any form of PTSD, be sure to speak to a qualified professional to help you get started in treating your post traumatic stress disorder.

Dissociative PTSD

It is possible for you to experience PTSD in a way where your symptoms are dissociative. In this case, you might experience one of the following:

Depersonalization: when you repeatedly feel detached from your body or your feelings. With depersonalization, you may feel as though you’re in a dream, or like things aren’t real, or as if you’re moving very slowly.
Derealization: when you repeatedly feel like the world around you isn’t quite real, but dreamlike, distant or distorted.

For dissociative PTSD, your symptoms cannot be caused by any substance, blackouts, alcohol or other medical conditions like seizures.

Delayed Expression PTSD

There is also Delayed Expression PTSD. With this type of PTSD, it may take at least six months after the traumatic event(s) for the full diagnostic criteria to be met, even if some of the symptoms show up sooner.

Complex Trauma PTSD

Also referred to as Complex Post Traumatic Stress Disorder, Complex Trauma is the result of cumulative, ongoing, or chronic trauma. With this type of PTSD, there is no DSM official diagnostic, however, it is recognized by the World Health Organization (WHO) as a systemic problem, especially in people from war torn countries.

War is not the only cause of C-PTSD, though, and if you or someone you love has undergone multiple traumatic event(s) or been in abusive relationships, and you exhibit some of the same symptoms of PTSD, then it is likely that you may be dealing with C-PTSD.

PTSD Treatment

Fully Recommended PTSD Treatment

Certain types of treatments are considered more reliable for treating PTSD and are used with greater frequency in both children and adults.

Cognitive Behavioral Therapy

The gold standard of therapy types. You can focus on your thoughts and feelings in a way that can lead to functional recovery by reshaping the way you approach different types of behaviors and thoughts patterns and how they relate to your trauma.

Goal: emotional regulation to influence behavioral patterns
Duration: 12-16 sessions
Mode: Individual or Group Sessions

Cognitive Processing Therapy

In this type of therapy you will challenge unhelpful beliefs that stem from your trauma and try to minimize the effects of the negative beliefs by putting things into an appropriate context.

Goal: Develop a healthier view of yourself and the world
Duration: 12 sessions
Mode: Individual

Cognitive Therapy

With Cognitive Therapy, you address the negative views and memories of trauma so that any disturbing behaviors or thought patterns can be modified so they no longer interfere with your daily functioning.

Goal: Removal of negative view for improved functionality
Duration: 12 sessions, performed weekly
Mode: Individual

Prolonged Exposure

Prolonged Exposure Therapy sessions usually last 1-2 hours at a time as they require time to process gradually increasing amounts of exposure to trauma related cues. These sessions help people to no longer avoid trauma related memories or external cues and learn that these cues are not inherently dangerous.

Goal: Gradual desensitization to triggers
Duration: Determined by need
Mode: Individual

Partially Recommended PTSD Treatment

The following types of therapy either don’t have as much data to show their effectiveness, or they also have some marginal element of potential harm, or are not as easily tolerated forms of therapy and so are only partially recommended.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR Therapy requires you to briefly remember the traumatic event(s) then engage in attention diverting movements with your eyes. The premise of this type of therapy is to shorten the amount of time you are exposing yourself to traumatic memories or stimuli.

Goal: to engage in exposure therapy in more manageable chunks of time
Duration: 6-12 sessions
Mode: Individual- no homework needed

Narrative Exposure Therapy

Narrative Exposure Therapy or NET is normally practiced amongst refugees. This type of therapy helps to contextualize the trauma you experienced within your life narrative so that you can better understand your experiences as only part of the whole and to gain perspective on what happened.

Goal: to help contextualize your trauma and gain perspective on your life as a whole
Duration: 4-10 sessions
Mode: Usually group

Brief Eclectic Psychotherapy

This type of therapy is normally used with individuals who have experienced a single traumatic event. With this type of therapy, you will tackle specific objectives with each session and learn to shed the emotions of shame or guilt surrounding your trauma.

Goal: to achieve emotional freedom and tackle individual challenges
Duration: 16 sessions
Mode: Individual

PTSD Medications

While talk therapies are considered to be the best form of treatment for PTSD, for some, medications can help to lower the degree of symptoms you experience and help to regulate your mood and emotions. Currently, Sertraline (Zoloft) and Paroxetine (Paxil) are the only FDA-approved medications meant to treat PTSD. However, if you struggle to tolerate these medications, your doctor may prescribe something different like Venlafaxine, or Fluoxetine.

Helping Someone with PTSD

Statistics in the United States indicate that at least 70% of adults and 30% of youth have all experienced at least one traumatic event in their lives. With these numbers, and the fact that we all live in a post-Covid world, it is likely that either you, or someone close to you, is dealing with, or has dealt with, some form of post traumatic stress disorder.

If you are currently in the middle of a challenging time, and are looking to be supportive to a loved one with PTSD there are some things to look out for, not only for your loved one, but also for yourself. With post traumatic stress disorder, there are several complications that can arise.

With that being said, having a healthy relationship with someone who is willing to understand or support a person with PTSD can make a world of a difference. If you are willing and able, your encouragement and gentleness could be a key part of someone’s recovery.

Anxiety and Depression

PTSD is a stressor related disorder, and Anxiety can arise from undue amounts of stress. With that being said, there are several types of Anxiety that a person with PTSD can develop.

If your loved one develops a form of Anxiety or Depression due to their PTSD, they may need someone close enough to them to spot the change and recommend that they seek proper diagnosis and treatment. The sooner any mental health challenge is addressed, the easier it is to overcome.

Insomnia

If your loved one struggles with sleep, or experiences nightmares, it is possible that their struggles are also affecting your ability to get proper rest. Some people are okay with taking sleep medications and finding helpful sleep rituals, or seeking therapy when their sleep issues become unmanageable, and that would be a great first step.

For anyone who is struggling with insomnia due to their own PTSD or that of a loved one, having an honest conversation about what is happening and how it is affecting your household may be a good first step for someone who is sensitive about their sleep issues.

This isn’t to guilt anyone with PTSD, but to help them understand that even if they are used to a new ‘normal’, nightmares and insomnia aren’t normal or healthy. Gentle reminders that they deserve regular, restful sleep and that seeking help for their issues isn’t a sign of weakness, but could be a good way to get them headed in the right direction.

Emotional Disregulation

We all have bad days. Sometimes we slip up. With PTSD, emotional outbursts become much more likely and for some can result in more extreme forms of aggression. If your loved one is someone with a more extreme form of emotional disregulation, you may not want to broach the subject with them while you’re alone. Having a trusted third party around to help defuse any outbursts is a helpful precaution worth taking.

If you don’t feel your loved one has extreme emotional disregulation, but still struggles with their emotions, it may be helpful for them to hear from you about what changes you’ve noticed, different patterns of behavior they’ve exhibited, and any other tangible descriptions of their emotions you can give. Again, gentleness and understanding of their struggles will go a long way.

Substance and Alcohol Abuse

Dealing with stress and a mental health condition is hard. Some people turn to substances or alcohol to help themselves deal with their issues. Keeping an eye on your loved one’s stress levels and coping strategies may help you to spot any issues earlier on so that they can be dealt with in a healthy manner, instead of spiraling into a problem with addiction as well as PTSD.

Communication with PTSD

I hope that if you’re still reading this you don’t feel disheartened by the outlook I’ve given you of life with someone with PTSD. Recovery is absolutely possible. Any love, support or understanding, or encouragement you can give to them may be life-changing. And remember, your loved one may struggle with their identity. Any time you address their PTSD or the symptoms of their PTSD, remember that they need to feel valued, not attacked or like they’re being graded as a human being. They’re going through a justifiably difficult time. Gentleness and honesty are some things to keep in mind as you encourage your loved one with post traumatic stress disorder.

As someone whose dealt with PTSD, I can tell you how invaluable a loved one’s help can be as you process your trauma. But I would never want someone to give me an emotional ‘blank check’ to do as I want to, or to overshare, especially if I get into an unhealthy pattern of living. Your loved one with PTSD wants to be healthy, and they want you to be healthy, too, even if they don’t say it out loud. They may struggle to ask for help, or struggle to realize what you or they need. Their coping mechanisms and behaviors may, at times, be hard to recognize.

I know that my ‘normal’ isn’t always healthy or normal, and having people who love me to help me out when I’m struggling is what gets me through the tougher times. Sometimes talking over how I’ve been doing recently helps to keep the lines of communication open. Giving little updates, not only helps me to assess where I’m at, but it also helps my loved ones to gain better insight into what my current needs are but without demanding a full informational download in each and every conversation.

Secondary Trauma Disorder

When you are exposed regularly to another person’s trauma, especially when they share the details of their trauma with you, it can cause something called Secondary Trauma Disorder. This disorder is more common in therapists, but caretaking for someone with PTSD can put you at risk for burnout, secondary trauma disorder, compassion fatigue or vicarious trauma. If you think you might be at risk for any of these, it may be healthy for you to reassess the ways in which you are caretaking for someone with PTSD, or to seek help, professional or otherwise.

Having someone at their side who’s willing to help is amazing, but if you find yourself at a potential breaking point, or even a strong turning point in your ability to help care for someone with PTSD, it is okay to say so.

We’re all human and need some form of healthy relationship boundaries to keep ourselves as individuals healthy, as well as maintain healthy relationships. Communicating your needs is just as important as someone dealing with PTSD. Even if you want to be strong and never show your struggles, in the end, you won’t be able to help in the way you want to if you don’t make time for regular wellness checks for yourself, as well as your loved one.

Conclusion

PTSD, or post traumatic stress disorder, is a trauma or stressor related disorder that can result in multiple symptoms that have the potential to lead to significant impairment. Early detection and appropriate forms of treatment, and/or medication, regular self care, plus healthy relational support systems all help to achieve remission.

May God Bless and Keep You.

Claire Evers