PTSD diagnosis

In order to diagnose^[15] PTSD, your healthcare provider will likely begin by asking about your signs and symptoms. They may also perform a physical exam to rule out other health conditions that may be causing your symptoms. A primary healthcare provider will likely refer you to a specialist, such as a psychiatrist. A specialist will likely consult the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders^[16] (DSM-5, published by the American Psychiatric Association) when diagnosing a disorder like PTSD. Some diagnostic criteria^[17] used to provide a diagnosis of PTSD in children, teens, and adults over the age of six include: 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 external reminders (such as people, places, conversations, activities, objects, or 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
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Difficulty falling or staying asleep or restless sleep

Also, clinically significant impairment or distress 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.