DSM-5-TR diagnostic criteria summary
Post-Traumatic Stress Disorder requires criteria across eight clusters:
- Criterion A (Exposure): Exposure to actual or threatened death, serious injury, or sexual violence, directly experienced, witnessed in person, learned of in close family/friend, or repeated/extreme exposure to aversive details (typical of first responders).
- Criterion B (Intrusion): One or more, recurrent intrusive memories, distressing dreams, dissociative reactions (flashbacks), intense distress at trauma cues, marked physiological reactions to cues.
- Criterion C (Avoidance): Persistent avoidance of trauma-related stimuli, internal reminders or external situations.
- Criterion D (Negative cognitions and mood): Two or more, inability to remember key features, persistent negative beliefs about self/others/world, distorted blame, persistent negative emotional state, anhedonia, detachment, inability to experience positive emotions.
- Criterion E (Arousal and reactivity): Two or more, irritable behavior/aggression, reckless behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance.
- Criterion F: Duration ≥1 month.
- Criterion G: Clinically significant distress or impairment.
- Criterion H: Not attributable to a substance or another medical condition.
Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 301–313.
Differential diagnosis
- Acute Stress Disorder (F43.0), symptoms persist 3 days to 1 month after trauma; if ≥1 month, transitions to PTSD.
- Adjustment Disorders (F43.21–F43.25), clinically significant distress in response to an identifiable stressor that does not meet PTSD Criterion A.
- Major Depressive Disorder (F33, F32), frequent comorbidity; depressive symptoms can dominate.
- Generalized Anxiety Disorder (F41.1), pervasive worry without trauma exposure history.
- Substance/Medication-Induced Conditions.
- Traumatic Brain Injury, complicates PTSD diagnosis when concussion or TBI co-occurs.
Common comorbidities
Lifetime comorbidity is the rule, not the exception, in PTSD. Common co-occurring conditions: Major Depressive Disorder (F33, F32), Substance Use Disorders (F10–F19), Generalized Anxiety Disorder (F41.1), and chronic pain conditions. Co-administer the PHQ-9, GAD-7, and AUDIT alongside the PCL-5 in clinical practice.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F43.10, p. 301–313.
- Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391.
- Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.