Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

Note: It is important to mention that the below criteria is of theoretical context only, and that PTSD encompasses physical attributes, habits and peculiarities that can only be diagnosed by a trained medical practitioner. Meeting the below criteria alone does not negate a PTSD diagnosis.

A. 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

B. The traumatic event is persistently reexperienced in one (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

C. 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)

D. 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

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

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

I find this version of the diagnostic criteria good because it moves physiological arousal to the re-expereincing category.

It is also a major numbing ritual, similar to the "It don't mean nothing" ritual used when someone was killed in Vietnam. The phrases, "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," contain a repetitious litany of Latin-rooted words, stepping back from the reality of almost being killed, having your body blown apart, seeing someone killed, etc. I don't want to get to graphic, these latinate words are embedded in a series of ors which create a soporific rhythm to the phrases. How can some young, middle-class health care provider identify what they are talking about?? It boggles the mind. And the soporific use of latinate words and the word or continues throughout the entire diagnosis.

On top of that, this is a diagnosis which was entirely absent from DSMII (Which actually came out during the TET offensive in 1968) although Gross Stress Reaction was present in DSM I. As a result of psychiatrist not being able to notice PTSD until Vietnam veterans were having flashbacks in the halls of the VA Hospitals, it has always been seen as a weird re-experiencing disorder with associated features, instead of the body's capacities to survive (numb so you can do what it takes to survive, hyperaroused in order to survive) being engaged and then unable to disengage, which, believe me, most trauma survivors find much more understandable. I think the whole criteria need to be re-written in plain English, and that two categories need to be added: a family element, since many people with PTSD manage to look 'resilient' i.e. financially successful (which in my opinion is not resilience) while the family carries and acts out the pain, and a physical element, since PTSD strongly affects health, and in at least one study of WWII combat vets receiving care at VA hospitals something like 30% with physical problems also had undiagnosed PTSD.