Table 1 DSM-5 criteria for PTSD

From: Post-traumatic stress disorder

Criterion* Description Specific examples Requirements Compared with DSM-IV
Criterion A Exposure to stressor • Direct exposure
• Witnessing trauma
• Learning of a trauma
• Repeat or extreme indirect exposure to aversive details
DSM-5 recognizes that exposure to trauma can occur either by direct or indirect confrontation with extreme trauma Specific definition of details of the stressor needed, including repeated experience or extreme exposure to details of events
Criterion B Intrusion symptoms • Recurrent memories
• Traumatic nightmares
• Dissociative reactions (flashbacks)
• Psychological distress at traumatic reminders
• Marked physiological reactivity to reminders
At least one of these five examples is required No change, but further clarification of the dissociative quality of flashbacks needed
Criterion C Persistent avoidance • Trauma-related thoughts or feelings
• Trauma-related external reminders such as people, places or activities
At least one of these two examples is required DSM-IV did not separate the avoidance criterion
Criterion D Negative alterations in cognitions and mood • Dissociative amnesia
• Persistent negative beliefs and expectations
• Persistent distorted blame of self or others for causing trauma
• Negative trauma-related emotions: fear, horror, guilt, shame and anger
• Diminished interest in activities
• Detachment or estrangement from others
• Inability to experience positive emotions
At least two of these seven examples are required DSM-IV noted social estrangement and restricted the range of affect; numbing redefined to positive rather than all affects
Criterion E Alterations in arousal and reactivity • Irritable and aggressive behaviour
• Self-destructive and reckless behaviour
• Hypervigilance
• Exaggerated startle
• Problems concentrating
• Sleep disturbance
At least two of these six examples are required Self-destructive and risk-taking behaviours were not defined in DSM-IV
Criterion F Duration Must experience criteria B, C, D and F for >1 month Acute stress disorder is diagnosed for symptoms occurring for <1 month post trauma No change
Criterion G Functional significance Impairment in social, occupational or other domains Disability in at least one of these domains is required No change
Criterion H Exclusion Not attributable to medication, substance use or other illness Symptoms must not be secondary to other causes Not stated in DSM-IV
Subtypes • Dissociative subtype: used when depersonalization and derealization occur in tandem with other symptoms described above.
• Delayed subtype: used to describe the emergence of symptoms following a period post trauma in which symptoms were not present or were present at a subthreshold level.
  1. DSM, Diagnostic and Statistical Manual of Mental Disorders; PTSD, post-traumatic stress disorder.
  2. *Criteria according to DSM-5 (Ref. 1).