How is a Post-Traumatic Stress Disorder (PTSD) diagnosis made? Not everyone who has experienced a traumatic event also has PTSD. Many people experience traumatic events during their life. After a traumatic event, it is normal to have strong feelings of anxiety, sadness, or stress. Some people may even experience some PTSD symptoms such as nightmares, memories about the event, or problems sleeping at night.
However, while you may be experiencing symptoms of PTSD, you do not necessarily have PTSD. Think of it this way: Headaches can be a symptom of a bigger problem, such as the flu. However, having a headache does not necessarily mean that you have the flu. The same is true for PTSD. Many of the symptoms of PTSD are part of the body's normal response to stress.
For this reason, mental health professionals have come up with specific requirements that must be met to get a diagnosis of PTSD. These requirements are referred to as Criteria A - F and are outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The six criteria for a PTSD diagnosis are described below. If you have not already done so, you should first learn about the basics of PTSD.
A person must have experienced a traumatic event where both of the following occurred:
- The person experienced, witnessed, or was confronted with an event where there was the threat of or actual death or serious injury. The event may also have involved a threat to the person's physical well-being or the physical well-being of another person.
- The person responded to the event with strong feelings of fear, helplessness, or horror.
The person experiences at least one of the following re-experiencing symptoms of PTSD:
- Frequently having upsetting thoughts or memories about a traumatic event.
- Having recurrent nightmares.
- Acting or feeling as though the traumatic event were happening again, sometimes called a "flashback."
- Having very strong feelings of distress when reminded of the traumatic event.
- Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.
The person experiences at least three of the following avoidance symptoms of PTSD:
- Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
- Making an effort to avoid places or people that remind you of the traumatic event.
- Having a difficult time remembering important parts of the traumatic event.
- A loss of interest in important, once positive, activities.
- Feeling distant from others.
- Experiencing difficulties having positive feelings, such as happiness or love.
- Feeling as though your life may be cut short.
The person experiences at least two of the following hyperarousal symptoms of PTSD:
- Having a difficult time falling or staying asleep.
- Feeling more irritable or having outbursts of anger.
- Having difficulty concentrating.
- Feeling constantly "on guard" or like danger is lurking around every corner.
- Being "jumpy" or easily startled.
The symptoms described above must have lasted for more than a month. If the symptoms have lasted for less than a month, you may have another anxiety disorder called Acute Stress Disorder.
The symptoms described above have a great negative impact on your life, interfering with work or relationships.
Making the Diagnosis
If you think you may have PTSD, it is important that you meet with a mental health professional trained in assessing and treating PTSD.
To determine whether or not you have PTSD, the clinician will interview you. The clinician will ask about all of the above symptoms, and he will determine whether or not they are being experienced strongly enough to be considered a problem.
In addition to PTSD, your treatment provider may also ask you about other psychological conditions often found to co-occur with PTSD, including major depression, substance use disorders, eating disorders, or anxiety disorders.
PTSD can be a difficult illness to cope with. Yet, there is hope. We are learning more and more about PTSD everyday, and a number of treatment options are available. You can learn more about treatments for PTSD through the following articles:
Cognitive-Behavioral Treatments (or CBT) for PTSD focus on changing the way in which people evaluate and respond to situations, thoughts, and feelings, as well as unhealthy behaviors that stem from thoughts and feelings.
Exposure therapy is a behavioral treatment for PTSD that aims to reduce a person's fear, anxiety, and avoidance behavior by having a person fully confront (or be exposed to) thoughts, feelings, or situations that are feared.
Acceptance and Commitment Therapy is a behavioral treatment that is based in the idea that our suffering comes not from the experience of emotional pain, but from our attempted avoidance of that pain. Its overarching goal is to help people be open to and willing to have their inner experiences while focusing attention not on trying to escape or avoid pain (because this is impossible to do) but instead, on living a meaningful life.
PTSD and substance abuse frequently co-occur, and therefore, several treatments have been developed that specifically target this co-occurrence. Seeking Safety is one such treatment.
Psychodynamic psychotherapy focuses on numerous factors that may influence or cause a person's symptoms, such as early childhood experiences, current relationships and the things people do to protect themselves from upsetting thoughts and feelings. Unlike CBT, psychodynamic psychotherapy emphasizes the role of the unconscious mind in our behaviors.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.