PTSD CRITERIA
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DSM-5-TR PTSD diagnostic criteria 2022
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DSM-5 PTSD diagnostic criteria full list
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DSM-5 PTSD full diagnostic criteria A B C D E symptoms list
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DSM-5-TR Diagnostic Criteria for PTSD
(Posttraumatic Stress Disorder — applies to individuals >6 years)
Classification: Trauma- and Stressor-Related Disorders
All criteria (A–H) must be met for diagnosis.
Criterion A — Exposure (≥1 required)
Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:
- Direct experience of the traumatic event
- Witnessing the event as it occurred to others (in person)
- Learning that the event occurred to a close family member or friend (must be violent or accidental)
- Indirect exposure — repeated or extreme exposure to aversive details (e.g., first responders, forensic investigators); does not apply to media exposure unless work-related
Criterion B — Intrusion Symptoms (≥1 required)
Persistent re-experiencing of the traumatic event:
- Recurrent, involuntary, intrusive distressing memories
- Recurrent distressing dreams (nightmares) related to the event
- Dissociative reactions / flashbacks — acting or feeling as if the event is recurring (can occur on a continuum up to complete loss of awareness of surroundings)
- Intense or prolonged psychological distress at exposure to trauma-related internal/external cues
- Marked physiological reactions to trauma-related cues
Criterion C — Avoidance (≥1 required)
Persistent effortful avoidance of trauma-related stimuli:
- Avoidance of distressing trauma-related thoughts or feelings
- Avoidance of external reminders (people, places, conversations, activities, objects, situations)
Criterion D — Negative Alterations in Cognition and Mood (≥2 required)
Beginning or worsening after the trauma:
- Inability to remember an important aspect of the traumatic event (dissociative amnesia; not due to head injury/substances)
- Persistent and exaggerated negative beliefs about oneself, others, or the world (e.g., "I am bad," "No one can be trusted")
- Persistent distorted blame of self or others for causing the trauma or its consequences
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, shame)
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions (emotional numbing; anhedonia)
Criterion E — Alterations in Arousal and Reactivity (≥2 required)
Beginning or worsening after the trauma:
- Irritable behavior and angry outbursts (with little/no provocation), verbal or physical aggression
- Reckless or self-destructive behavior
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance (difficulty falling/staying asleep, restless sleep)
Criterion F — Duration
Symptoms from Criteria B, C, D, and E persist for >1 month
Criterion G — Functional Impairment
Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Criterion H — Exclusion
Symptoms are not attributable to physiological effects of a substance (medication, alcohol) or another medical condition
Specifiers
| Specifier | Description |
|---|---|
| With dissociative symptoms | Meets full criteria + persistent depersonalization (detached from self/mental processes) or derealization (unreality of surroundings) |
| With delayed expression | Full criteria not met until >6 months after the event (some symptoms may appear earlier) |
Special Populations
Children ≤6 Years (Preschool Subtype — DSM-5-TR change)
- Modified algorithm: ≥1 intrusion symptom (B) + ≥1 avoidance or negative cognition symptom (C) + ≥2 arousal symptoms (D)
- DSM-5-TR removed the note excluding electronically-witnessed events for this age group (since Criterion A.2 already requires in-person witnessing)
Key DSM-IV → DSM-5 Changes
| Feature | DSM-IV | DSM-5 |
|---|---|---|
| Symptom clusters | 3 (B, C, D) | 4 (B, C, D, E) — cognition/mood split from arousal |
| Subjective fear response | Required (fear, helplessness, horror) | Removed |
| Sudden unexpected death of loved one | Counted as Criterion A | Excluded |
| Avoidance symptoms required | 3 of 7 | 1 of 2 (dedicated cluster) |
| Criteria count | 17 symptoms | 20 symptoms |
No changes to adult PTSD criteria were made in DSM-5-TR (2022). The only DSM-5-TR update relevant to PTSD was a minor clarification in Criterion A.2 for children ≤6 years.
Sources: DSM-5-TR (APA, 2022); VA National Center for PTSD; AAFP Am Fam Physician 107(3), March 2023; Kaplan & Sadock's Comprehensive Textbook of Psychiatry
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