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Medical Author:

Maria Pease, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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PTSD Diagnosis

PTSD is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and requires the following symptoms:

DSM-IV-TR Criteria for PTSD

The person has been exposed to a traumatic event in which both of the following were present:

A.

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.

The traumatic event is persistently re-experienced in one (or more) of the following ways:

B.

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions

2. Recurrent distressing dreams of the event

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)

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

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:

C.

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 (for example, unable to have loving feelings);

7. or sense of a foreshortened future (for example, does not expect to have a career, marriage, children, or a normal life span).

Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

D.

1. difficulty falling or staying asleep,

2. irritability or outbursts of anger,

3. difficulty concentrating,

4. hypervigilance,

5. and/or exaggerated startle response.

The duration of the disturbance (symptoms in criteria B, C, and D) is more than one month.

F.

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

PTSD is a clinical diagnosis; there are no laboratory tests or brain-imaging studies currently used in clinical practice to diagnose PTSD. Brain imaging studies are under way to learn more about the brain in the PTSD condition, but these are not used in everyday medical practice. A physical exam and some blood tests may be necessary to rule out medical conditions that may mimic PTSD, such as hyperthyroidism which can create an anxiety state.