PTSD Diagnosis: Guidelines, Methods, And What Happens Next

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/28/2020

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Movies and books have offered many portrayals of people with PTSD. So, many of the symptoms are well-known. Yet, having a casual understanding of this disorder isn’t enough if you think you might have it. PTSD needs to be diagnosed by a mental health professional. Only then can you be sure and get treatment if you need it. Here’s a look at how PTSD diagnosis works and what comes next.

How to Tell If You Have PTSD

Suppose you identified with a fictional character who had PTSD. Or maybe you see symptoms of posttraumatic stress disorder in yourself. What can you do to find out the truth? One way to start is to take an online PTSD screening test.

The quiz can’t diagnosis you, but it can help you in deciding about moving forward with seeking treatment. After answering questions about your emotional reactions, behaviors, and experiences, you get the results instantly. You see a graphic illustration that shows how significant your symptoms of PTSD are. The next step is to talk to a mental health professional. Their first job will be to diagnose your condition.

How Is PTSD Diagnosed?

The Diagnostic and Statistical Manual is a guide that gives specific information about how to diagnose PTSD and other mental disorders. The current version is DSM-5. The mental health professional making the diagnosis assesses your symptoms and compares them to the diagnostic handbook criteria.

DIAGNOSTIC CRITERIA FOR PTSD

The DSM-5 lists a set of criteria that must be met before a psychiatrist or psychologist can diagnose PTSD. These PTSD diagnostic criteria include both symptoms and other facts about how the symptoms show up. In addition, the professional making the diagnosis may specify other factors related to the PTSD.

EXPOSURE TO THREAT

The first part of diagnosing PTSD is to identify the traumatic event that happened before the symptoms started. Trauma occurs when you’re exposed to death, severe injury, or sexual violence. Trauma can also come from a threat that these things will happen.

The PTSD diagnosis requires that you’ve been exposed or threatened in one or more of these ways:

  • You experienced the traumatic event directly.
  • You were there watching when it happened to someone else.
  • You found out your friend or family member was threatened or died violently or accidentally.
  • You repeatedly experienced exposure to traumatic events that happened to others. For example, you might develop PTSD if you’re a police officer who often violent crimes.

It’s important to note that PTSD doesn’t usually happen because of things you saw on TV, online, or in pictures. There might be a few exceptions, such as viewing violent images as a part of your work.

INTRUSION SYMPTOMS

After the event is over, you may experience what psychologists call intrusion symptoms. These are symptoms that bring up the traumatic event while you’re trying to carry on your normal activities. If you have PTSD, you have one of the following symptoms of this type.

  • You have recurring and distressing memories of the event when you’re not trying to think about it.
  • You have recurrent nightmares that include details and emotions related to the traumatic event.
  • You have flashbacks or other dissociative reactions that you feel and behave as if the trauma was happening right now instead of in the past. At their most severe, these flashbacks may cause you to completely lose touch with your present situation and environment.
  • You experience intense distress when you’re exposed to things that are similar to or symbolize the traumatic event. These cues might come from the environment or from within yourself.
  • You have physiological reactions triggered by things that resemble some aspect of the traumatic event.

AVOIDANCE SYMPTOMS

You may begin to avoid certain things after the trauma is over. If you have PTSD, you avoid or try to avoid one of the two following things.

  • Distressing memories, feelings, and thoughts you associate with the traumatic event.
  • External reminders of the traumatic event, such as people, activities, and places you associate with the traumatic event.

NEGATIVE CHANGES IN THOUGHTS AND MOODS

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Your thoughts and moods might change dramatically after you experience a traumatic event. In diagnosing PTSD, your psychiatrist or psychologist will consider this criterion met if two or more of the following is true:

  • You can’t remember important aspects of the traumatic event.
  • You have ongoing negative beliefs that are exaggerated. These beliefs may be about yourself, people you know, or the world in general. You may have had negative thoughts before the trauma, but if so, they get much worse afterward.
  • You have distorted thoughts about the cause of the event or the consequences of it. This leads you to blame yourself for the event happening.
  • Your mood is consistently negative. You may go around feeling fearful, horrified, angry, or guilty after the event happened.
  • You lose interest in activities that were once important to you, and you may stop doing them altogether.
  • You feel detached or estranged from others.
  • You can’t experience positive emotions like happiness, love, or satisfaction anymore.

CHANGES IN AROUSAL AND REACTIVITY

The way you react to people often changes after you experience a traumatic event. The DSM-5 lists the following symptoms of PTSD related to arousal and reactivity. If you have two or more of these, you’ve met this criterion for PTSD.

  • You behave in irritable, angry, or aggressive ways. You may express these feelings verbally, by having angry outbursts, or by being physically aggressive.
  • You engage in self-destructive or reckless behavior.
  • You’re hypervigilant. That is, you experience extreme alertness, even when there is no real danger.
  • You’re startled easily and often.
  • You have trouble concentrating.
  • You find it hard to fall asleep or stay asleep, or your sleep is restless.

OTHER FACTORS

In each category, the symptoms must last more than one month. The problem must also be severe enough to cause you significant distress or impair your work, social interactions, or other areas of your life. Finally, these symptoms are not caused by another medical problem or by substance abuse.

ADDITIONAL SPECIFIERS

Along with the primary PTSD diagnosis, the mental health professional may add a specifier about the types of symptoms you have. These specifiers are a part of the diagnosis if you have them with your PTSD.

The first specifier is PTSD with dissociative symptoms. If you experience either of these types of symptoms, the specifier will be added. First, you may experience depersonalization, in which you often feel detached from your thoughts or body. Second, you might experience derealization, in which you experience the world as being unreal.

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The other specifier that can be used is PTSD with delayed expression. This specifier applies if you don’t meet the diagnostic criteria until at least six months after the event. You may have some symptoms, but not enough of them for a diagnosis of PTSD.

WHAT IS A PTSD ASSESSMENT LIKE?

The DSM-5 offers a reliable foundation for diagnosing PTSD. But it’s only a guide. You might wonder, “How does the mental health professional know if those criteria apply to me as an individual?” That knowledge only comes after a careful assessment of the traumatic event you experienced and how it’s affecting your thoughts, behaviors, and reactions. A PTSD assessment might consist of one or more PTSD scales and a structured interview.

PTSD Scales

PTSD scales contain a list of specific questions for the therapist to ask. They’re similar to a screening quiz in that each item is about symptoms of the disorder. It’s also similar in that it usually gives a number score at the end. However, it’s different because a mental health professional administers them. After the scale is completed, your therapist will have more information on whether you have PTSD and how severe your condition is.

Structured Interviews For PTSD

Like PTSD scales, structured interviews are designed to identify the symptoms and severity of PTSD. Recently, structured interview methods have been developed or updated. For example, the Structured Clinical Interview, PTSD Module (SCID PTSD), was updated to match the criteria in the DSM-5.

A structured interview doesn’t have a number score like a PTSD scale. Instead, it’s designed to give the clinician a more thorough understanding of your symptoms and your unique situation. If a mental health professional gives you a diagnosis of PTSD, they’ve most likely learned about you through PTSD scales and structured interviews. They can then compare your unique situation to the information in the DSM-5 when they decide if you do or don’t meet the criteria for PTSD.

What to Do Next: Treatment Methods

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Getting treatment for PTSD is essential to your sense of well-being and your ability to function in your life. Usually, the preferred treatments for PTSD fall into the category of trauma-focused psychotherapies. These include:

  • Prolonged Exposure Therapy
  • Cognitive Processing Therapy
  • Eye Movement Desensitization and Reprocessing

Conclusion

Seeking diagnosis and treatment may seem scary at first. Or it may feel like a lost cause. But with effective treatments, you can relieve your symptoms of PTSD, heal from your trauma, and move more confidently towards a brighter future.