Diagnosis of Posttraumatic Stress Disorder (PTSD)

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Diagnosis of Posttraumatic Stress Disorder (PTSD)

There is no laboratory test for PTSD. The diagnosis of PTSD is based on the clinical history of the patient and the occurrence of a traumatic event. A diagnosis of PTSD cannot be made without a clear history of a traumatic event.

The American Psychiatric Association (APA) specifies the symptoms and criteria for PSTD in its Diagnostic and Statistic Manual of Mental Disorders:

Diagnostic Criteria for Posttraumatic Stress Disorder

The person has been exposed to a traumatic event in which both of the following were present:
1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2. The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
The traumatic event is persistently reexperienced in (or more) of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have loving feelings)
7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hypervigilance
5. Exaggerated startle response
Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

APA. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994. Washington, DC: American Psychiatric Association (APA).

Another tool used to evaluate symptoms of PTSD is the Clinician-Administered PTSD Scale (CAPS), a self-reporting questionnaire that assesses the nature of trauma, the patient's current condition, and the prognosis. The CAPS also helps identify associated conditions or complications, such as guilt and an impaired sense of surroundings.

Differential Diagnosis
Other conditions cause many of the symptoms experienced in PTSD and these conditions must be ruled out. Additionally, conditions such as substance abuse and depression develop as complications of PTSD. Ultimately, the distinguishing factor is the fact that the patient has experienced a severe trauma.

Some of the conditions that must be ruled out include the following:

Adjustment disorder
Depression
Panic disorder
Substance abuse or dependence disorder

Furthermore, malingerers — that is, people who falsely claim to be traumatized—sometimes feign PTSD symptoms in order to win money in a court case as compensation for "emotional suffering."

Course

The course of PTSD is often determined on when the person begins to experience symptoms.

Immediate Onset

Better response to treatment
Better prognosis (i.e., less severe symptoms)
Fewer associated symptoms or complications
Symptoms are resolved within 6 months

Delayed Onset

Associated symptoms and conditions develop
Condition more likely to become chronic
Possible repressed memories
Worse prognosis

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People who experience trauma sometimes repress their memories of the event to avoid the pain of thinking about or remembering them. These so-called repressed memories sometimes resurface during therapy or may be triggered by something in everyday experience that reminds the patient of the traumatic event.

Working with repressed memories in therapy is controversial, because many therapists doubt their validity and accuracy. Repressed memories are typically retrieved during hypnosis, which many psychiatrists consider an unreliable tool for memory exploration.

About 50% of those who have acute onset of symptoms recover within 6 months. Roughly 30% develop chronic symptoms that may affect them for the rest of their lives. Others experience intermittent periods of symptom severity and remission.

Last updated: Jan. 2002

Diagnosis of Posttraumatic Stress Disorder (PTSD)

Diagnostic Criteria for Posttraumatic Stress Disorder

Course

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