PTSD is diagnosed after a person experiences symptoms for at least one month following a traumatic event. However, symptoms may not appear until several months or even years later. The disorder is characterized by three main types of symptoms:
- Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
- Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
- Increased arousal such as trouble sleeping and concentrating, feeling jumpy, and being easily irritated and angered.
Diagnosis criteria that apply to adults, adolescents, and children older than six include those below.
Exposure to actual or threatened death, serious injury, or sexual violation:
- directly experiencing the traumatic events
- witnessing, in person, the traumatic events
- learning that the traumatic events occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental
- experiencing repeated or extreme exposure to aversive details of the traumatic events (Examples are first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless exposure is work-related.
The presence of one or more of the following:
- spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events (Note: In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.)
- recurrent distressing dreams in which the content or affect (i.e. feeling) of the dream is related to the events (Note: In children there may be frightening dreams without recognizable content.)
- flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring (Note: 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 events
- physiological reactions to reminders of the traumatic events
Persistent avoidance of distressing memories, thoughts, or feelings about or closely associated with the traumatic events or of external reminders (i.e., people, places, conversations, activities, objects, situations)
Two or more of the following:
- inability to remember an important aspect of the traumatic events (not due to 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”).
- persistent, distorted blame of self or others about the cause or consequences of the traumatic events
- persistent 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
Two or more of the following marked changes in arousal and reactivity:
- irritable or aggressive behavior
- reckless or self-destructive behavior
- exaggerated startle response
- problems with concentration
- restless sleep, inability to fall asleep, not able to stay asleep
Also, clinically significant distress or impairment in social, occupational, or other important areas of functioning not attributed to the direct physiological effects of medication, drugs, or alcohol or another medical condition, such as traumatic brain injury.