PTSD diagnostic criteria

The Second World War led to the emergence of specific psychopathological disorders as a result of long-term effects of the trauma. Psychiatrists and psychologists in different countries are faced with necessity of treatment and social rehabilitation of the largest contingent. The victims of the concentration camps and the former prisoners deported during the war with persistent neuropsychic disorders needed a special treatment.

After analysis of extensive observations and studies of Vietnam veterans and survivers of various disasters, in 1980 the post-traumatic stress disorder (PTSD) was included in Diagnostic and Statistical Manual of Mental Disorders (DSW-III) – a classification standard, developed by American Psychiatric Association. In 1995, the US introduced a new fourth edition (DSM-IV) with somewhat softened approach to assessment of psychological traumatic situation, where any traumatic event might be accepted.

In 1995, PTSD and PTSD diagnostic criteria have been introduced in the 10th revision of the International Classification of Diseases (ICD-10), which is the main diagnostic standard in European countries. In the last revision of ICD-10 PTSD is treated as a separate disorder. For the fuller picture of PTSD see some diagnostic criteria according to DSM-IV:

A. The person has been exposed to traumatic event with both of the following conditions presented:

  • The person experienced, witnessed or faced the traumatic event/events that involved death or threat of death or serious injury, or threat to the physical integrity of self or others;
  • The person’s reaction to this event involves intense fear, helplessness or horror.

B. The traumatic event is persistently reexperienced in one of the following ways:

  • Recurrent and intrusive recollections of the event, causing suffering, which include images, thoughts or perceptions.
  • Repeated distressing dreams of the event.
  • Actions or feeling as if the traumatic event were repeated (includes re-experiencing of feelings, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
  • Acute adjustment disorder in result of exposure to internal or external stimuli that symbolize or resemble an aspect of the traumatic event.
  • Physiological reactivity in response to external or internal stimuli that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma, emotional blocking and numbing (not observed before the trauma) is indicated by the presence of three (or more) of the following:

  • Efforts to avoid thoughts, feelings or conversations associated with the trauma;
  • Efforts to avoid activities, places, or people that arouse recollections of the trauma;
  • Inability to recall important aspects of the trauma (circumscribed amnesia);
  • Markedly diminished interest or participation in previous significant activities;
  • Feeling of detachment or separation from others;
  • Limited range of emotional expression (eg, inability to have loving feelings);
  • A sense of foreshortened future (for example, lack of expectations about career, marriage, children or normal life).

D. Persistent signs of increased arousal (not observed before the trauma) is indicated by the presence of at least two of the following symptoms:

  • Difficulty falling or staying asleep (early awakening);
  • Irritability or outbursts of anger;
  • Difficulty concentrating;
  • Hypervigilance, a state of constant expectation of something bad;
  • Exaggerated startle response.

E. Duration of the disturbance (symptoms in PTSD diagnostic criteria B, C and D) is more than 1 month.

F. The disorder causes clinically significant distress or impairment in social, occupational or other important life spheres.