Diagnostic criteria for PTSD based on Diagnostic and Statistical Manual of Mental Disorders IV, Text Revision
To make the formal diagnosis of PTSD the following diagnostic criteria must be met:
1. Exposure to traumatic event
- Experiencing, witnessing or being confronted with an event involving serious injury, death or a threat to person’s physical integrity
- Response, involving helplessness, intense fear or horror
- Agitation or disorganized behavior for children
2. Persistent re-experiencing
- Thoughts or perception, images, dreams, illusions, hallucinations, dissociative flashback episodes, intense psychological distress or reactivity to situations that remind of the event
- Children re-experience the event through repetitive play.
3. Avoidance and emotional numbing - 3 or more of the following must be present:
- Avoidance of thoughts, feelings or conversations that are associated with the event
- Avoidance of places, people, or activities that may trigger recollection of the event
- Inability to recall important aspects of the event
- Significantly diminished interest or participation in important activities
- Feeling of detachment from others
- Narrowed range of effect
- Sense of having a foreshortened future
4. Hyperarousal – 2 or more of the following symptoms must be present
- Difficulty sleeping or falling asleep
- Decreased concentration
- Outbursts or anger or irritable mood
- Exaggerated and started response
5. Duration of symptoms for more than 1 month
If the above-mentioned symptoms are present, but 30 days have not elapsed, the individual is diagnosed with Acute Stress Disorder.
6. Significant impairment in functioning
Children may react differently to trauma than adults.
For children 5 years or younger:
- Typical reactions can include fear of being separated from parent, crying, whimpering, screaming, immobility, aimless motion, trembling, frightened expressions, excessive cling.
- Regressive behavior may also be observed.
Children aged 6-11 years may show:
- Extreme withdrawal, disruptive behavior, inability to pay attention, regressive behavior, nightmares, sleep problem, irrational fears, irritability, refusal to attend school, outbursts of anger, fighting
- Somatic complaints without medical basis
- Depression, anxiety, feeling of guilt, emotional numbing