DSM-5 Diagnostic Criteria for
Posttraumatic Stress Disorder
A.  Exposure to actual or threatened death, serious injury, or sexual violence in one
(or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
B.  Presence of one (or more) of the following intrusion symptoms associated
with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

2. Recurrent distressing dreams in which the content and/or affect of the dream are related to
the traumatic event(s).

3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring.  (Such reactions may occur on a continuum, with the most
extreme expression being a complete loss of awareness of present surroundings.)

4. Intense or prolonged psychological distress at exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event(s).

5. Marked psychological reactions to internal or external cues that symbolize or resemble an
aspect of the traumatic event(s).
C.  Persistent avoidance of stimuli associated with the traumatic event(s), beginning
after the traumatic event(s) occurred, as evidenced by one or both of the following:
E.  Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or
worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following:
G.  The disturbance causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as
verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F.  Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or
closely associated with the traumatic event(s).

2. Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
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3. Learning that the traumatic event(s) occurred to a close family member or
close friend.  In cases of actual or threatened death of family member or friend,
the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media,
television, movies, or pictures, unless this exposure is work related.
D.  Negative altercations in cognitions and mood associated with the traumatic event(s), beginning
or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to
dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

2. 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,” “My whole
nervous system is permanently ruined”).

3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that
lead the individual to blame himself/herself or others.

4. Persistent negative emotion state (e.g., fear, horror, anger, guilt, or shame).

5. Markedly diminished interest or participation in significant activities.

6. Feelings of detachment or estrangement from others.

7. Persistent inability to experience positive emotions (e.g., inability to experience happiness,
satisfaction, or loving feelings).
H.  The disturbance is not attributable to the physiological effects of a substance (e.g., medication,
alcohol) or another medical condition.
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