In the first post in this series, we discussed the basic PTSD criteria found in the DSM-V. In this post, we will explore a few specifications of the condition and put all the criteria together.
It’s important to note that the DSM-V recognizes two specifications for PTSD diagnoses in addition to the eight initial diagnostic criteria. These specifications may not be present in every PTSD case.
This specification applies to individuals who meet all PTSD criteria and who also experience dissociative symptoms when exposed to reminders about the traumatic event. One dissociative symptom is depersonalization, which is the experience of being detached from oneself and one’s surroundings or feeling like an outside observer or as if one is only dreaming. Someone experiencing depersonalization may have an “out of body” experience. Another symptom characteristic of a dissociative specification is derealization. With derealization, the individual may experience reminders of the trauma as though the reminders are not really happening, or believing the event or the reminders to be “unreal.” Similarly to depersonalization, derealization is a way for the individual to mentally distance themselves from the traumatic event.
This specification applies when the full diagnostic criteria are not met until at least six months after the initial traumatic event. In this specification, an individual may experience some symptoms immediately after the trauma, but not the full range of symptoms required for a diagnosis. In other cases, an individual may seem to be functioning perfectly normally with no symptoms at all until some time passes or a significant event such as the loss of a loved one or a life change such as a divorce or retirement brings on worsening symptoms. Regardless of when the symptoms appear, the individual must meet the full diagnostic criteria in order to receive a diagnosis of PTSD.
Now that we have explored the DSM-V criteria as well as possible specifications, let’s put it all together with an example.
The DSM-V Criteria in Action
An Army veteran witnessed the death of fellow soldiers and enemies in combat (Criterion A) and suffers from flashbacks and nightmares about the combat (Criterion B). The veteran hates talking about war or being exposed to any depictions of violence because she does not like to be reminded of her experiences (Criterion C). The veteran tends to blame herself for what happened and is often depressed, showing little interest in her former activities (Criterion D). Ever since the veteran’s combat experience, she is “jumpy” and often has an outsize response to relatively small surprises. The veteran does not sleep well and is often irritable. (Criterion E). The combat happened fifteen years ago, but the veteran began experiencing her current symptoms ten years ago, after the death of an Army buddy (Criterion F, with Delayed Specification). The veteran has experience working in an office but has had a hard time keeping a job because it is difficult for the veteran to be around people without snapping at them and the veteran struggles with concentrating during tasks (Criterion G). The veteran’s healthcare professionals have determined that the veteran’s symptoms do not stem from alcohol abuse, medication, or any other condition (Criterion H).
While the above example is somewhat simplistic, it is intended to provide a picture of what many veterans struggling with PTSD experience and how this disorder can affect many aspects of life. With the exception of Criterion H, each individual case may fulfill the criteria in totally unique ways. Recall that Criterion F requires the duration of symptoms longer than one month, but there is no upper diagnostic limit to how long PTSD symptoms may last.
If you are wondering how the VA rates PTSD and other mental disorders, you can read more in our other recent blog post.