Post-traumatic stress disorder (PTSD) can develop after a person experiences a life-threatening or traumatic event which impairs their ability to function. With proper and accurate PTSD diagnosis, an effective treatment plan can be devised to help the patient recover fully…
As there is no specific lab test to diagnose post traumatic stress disorder, it can be challenging to diagnose patients accurately. Moreover, as sufferers are often reluctant to recall the traumatic event or to discuss their symptoms, it can make the process more difficult. However, a patient must be diagnosed by an experienced and trained mental health professional, such as a psychologist, psychiatrist, therapist or a psychiatric nurse practitioner.
For an accurate PTSD diagnosis, the symptoms must be severe and disrupt the daily functioning of the sufferer and interfere with their work, education and interpersonal relationships. A patient must experience the symptoms for at least one month or more in order to be diagnosed with PTSD. According to the DSM-5, a patient must meet the following the diagnostic criteria 1 :
1. Criterion A
A patient must be exposed to one or multiple traumatic events that involve real or threatened death, injury, or even sexual violence through one or more of the ways mentioned below:
- Direct exposure to or experiencing the traumatic event(s)
- Personally witnessing the event(s) as it occurred to another person
- Learning about the occurrence of the traumatic event(s) to a family member, close relative or friend. In case of threatened or actual death of a loved one, the event(s) should be accidental or violent.
- Indirect, extreme and repeated exposure to aversive details of the traumatic event(s). For instance, police officers and first responders. This does not involve exposure through electronic media, television, pictures or movies, unless such exposure is related to work.
2. Criterion B
For proper PTSD diagnosis, a sufferer must meet at least one of the following symptoms linked with the traumatic event(s), starting after the occurence of the event:
- Involuntary, recurrent & intrusive distressing thoughts and memories associated with the traumatic event(s). In children above 6 years of age, this can be expressed through repetitive play involving aspects or themes of traumatic event(s).
- Distressing and recurrent nightmares with the content of the disturbing dreams associated with traumatic event(s). Children can experience terrifying dreams and they may be unable to recognize the content.
- Dissociative reactions, like flashbacks, where the person thinks, feels or behaves as if the traumatic event(s) are recurring. These reactions may take place on a continuum which can vary from minor responses to a total loss of awareness of themselves or their surroundings. For children, trauma-specific reenactment can take place while in play.
- Prolonged or severe psychological distress experienced when exposed to external or internal reminders that may resemble or symbolize aspects of the traumatic event(s).
- Marked physiological reactions when exposed to traumatic reminders, such as high blood pressure or increased heart rate.
3. Criterion C
Recurrent avoidance of cues or reminders related to the event(s) starting after the trauma, as exhibited by one or both of these:
- Avoidance or attempts to avoid difficult and distressing thoughts, feelings or memories associated with the traumatic event(s).
- Avoidance or attempts to avoid external stimuli or reminders, like places, activities, people, objects, situations or conversations which can trigger or provoke distressing emotions, memories or thoughts about the event(s).
4. Criterion D
This is another crucial criteria for accurate PTSD diagnosis. Negative changes in cognition and mood which started or got worse after the traumatic event(s), as indicated by two or more of the following:
- Incapability to remember certain crucial aspects of the traumatic event(s), usually due to dissociative amnesia but not caused by other factors like alcohol, substance use or head injury.
- Distorted, exaggerated and persistent negative expectations or beliefs about themselves, others or the world in general.
- Repeated distorted cognitions regarding the consequences or causes of the traumatic event(s) making the person blame themselves or others.
- Constant negative emotional state, such as shame, guilt, fear or anger.
- Noticeably reduced participation or interest in important activities which used to be enjoyable.
- Feelings of isolation, estrangement or detachment from others.
- Persistent inability to experience or enjoy positive emotions, like feelings of love, satisfaction, inner peace or happiness.
5. Criterion E
Noticeable trauma-related alterations in arousal and reactivity which began or worsened after the occurence of the traumatic event(s), as demonstrated by two (or more) of the following:
- Irritability and angry outbursts, with little or no stimuli, mostly expressed physically or verbally toward objects or people.
- Reckless or self-destructive behavior.
- Increased startle response.
- Difficulty concentrating.
- Sleep disturbances or trouble falling or staying asleep.
6. Criterion F
This criteria for PTSD diagnosis is associated with the duration of the symptoms for post traumatic stress disorder. The duration of disturbance must include Criterion B, C, D, and E for over one month.
7. Criterion G
The disturbance leads to clinically substantial impairment or distress in different aspects of life, such as personal, social, occupational or other vital areas of functioning.
8. Criterion H
The disturbance or symptoms are not caused by the physiological effects of a substance use, like alcohol, drugs or medication, or due to another medical condition. This is another important aspect of PTSD diagnosis.
Screening Of Post Traumatic Stress Disorder
A doctor or mental health professional can diagnose the disorder after conducting certain lab tests and physical exams. According to Harvard Medical School, a doctor may ask the patient about the traumatic events which triggered the symptoms and they will “ask about your life history and will ask you to describe both positive experiences and negative or traumatic ones. Your current circumstances are very important.” The doctor may also conduct a mental health screening test as it can help in accurate PTSD diagnosis and analyze if someone has PTSD or not. The duration of the assessment usually varies, however it can be a long process, if a disability claim or legal implications are involved. According to research 2 , “A full assessment that equates to a standard mental health assessment is needed to diagnose the disorder.” The assessment must consider different aspects, such as presentation of the screening test, risk assessment result, mental state examination result and social factors, like information from other sources and support network.
A number of screening instruments 3 are available for the assessment of the mental disorder, including a Trauma Screening Questionnaire (TSQ 4 ). It is a 10-item symptom screen test that was originally developed to help people suffering from traumatic stress. The United States Department of Veterans Affairs states “The TSQ is based on items from the PTSD Symptom Scale – Self Report and has five re-experiencing items and five arousal items.” Certain screening tests have been developed as self-reports and even as “clinician-administered instruments” especially designed for analyzing adult PTSD. Some of these screening instruments for accurate PTSD diagnosis include:
- Davidson Trauma Scale 5
- Distressing Event Questionnaire 6
- Impact of Event Scale-Revised
- Trauma Symptom Checklist-40
- PTSD Checklist-Civilian Version 7
- Revised Civilian Mississippi Scale for PTSD 8
- The Posttraumatic Stress Diagnostic Scale
- Trauma Symptom Inventory
- Los Angeles Symptom Checklist
- The Clinician-Administered PTSD Scale (CAPS)
- PTSD Checklist-Military Version
- The Mississippi Scale for Combat-Related PTSD (M-PTSD)
- PTSD Keane scale (PK scale)
- The PTSD module
Once an accurate PTSD diagnosis has been conducted by a healthcare professional, one should seek immediate medical treatment as the crippling symptoms of post-traumatic stress disorder can impair work, relationships, social interaction and even personal lives. Treatment can significantly help in overcoming the symptoms and building a more positive and healthier life. Make sure to work with an experienced and qualified professional who can devise the best treatment plan based on your individual needs, concerns and trauma.References:
- Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
- Bisson J. I. (2007). Post-traumatic stress disorder. BMJ (Clinical research ed.), 334(7597), 789–793. https://doi.org/10.1136/bmj.39162.538553.80
- Brewin CR. Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress. 2005 Feb;18(1):53-62. doi: 10.1002/jts.20007. PMID: 16281196.
- Brewin, C. R., Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C., Turner, S., & Foa, E. B. (2002). Trauma screening questionnaire. PsycTESTS Dataset. https://doi.org/10.1037/t04710-000
- Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, Hertzberg M, Mellman T, Beckham JC, Smith RD, Davison RM, Katz R, Feldman ME. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med. 1997 Jan;27(1):153-60. doi: 10.1017/s0033291796004229. PMID: 9122295.
- Kubany ES, Leisen MB, Kaplan AS, Kelly MP. Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ). Psychol Assess. 2000 Jun;12(2):197-209. doi: 10.1037//1040-3522.214.171.124. PMID: 10887766.
- Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996 Aug;34(8):669-73. doi: 10.1016/0005-7967(96)00033-2. PMID: 8870294.
- Norris FH, Perilla JL. The revised Civilian Mississippi Scale for PTSD: reliability, validity, and cross-language stability. J Trauma Stress. 1996 Apr;9(2):285-98. doi: 10.1007/BF02110661. PMID: 8731548.