Post traumatic Stress Disorder

The following criteria apply to adult, adolescents and children older than
6 years for children 6 years and younger see corresponding criteria below
(1). All of the criteria are required for the diagnosis of PTSD. The following
text summarizes the diagnostic criteria:

Criterion A (one required): The person was exposed to: death, threatened
death, actual or threatened serious injury, or actual or threatened sexual
violence, in the following way(s):

Direct exposure

Witnessing the trauma

Learning that a relative or close friend was exposed to a trauma

Indirect exposure to aversive details of the trauma, usually in the course

of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-

experienced, in the following way(s):

Intrusive thoughts

Nightmares

Flashbacks

Emotional distress after exposure to traumatic reminders

Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the

trauma, in the following way(s):

Trauma-related thoughts or feelings

Trauma-related reminders
Criterion D (two required): Negative thoughts or feelings that began or
worsened after the trauma, in the following way(s):

Inability to recall key features of the trauma

Overly negative thoughts and assumptions about oneself or the world

Exaggerated blame of self or others for causing the trauma

Negative affect

Decreased interest in activities

Feeling isolated

Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began

or worsened after the trauma, in the following way(s):

Irritability or aggression

Risky or destructive behavior

Hypervigilance

Heightened startle reaction

Difficulty concentrating

Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment

(e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use,

or other illness.
Posttraumatic Stress Disorder for Children 6 Years and Younger
A.In children (younger than 6 years), exposure to actual or threatened death,
serious injury, or sexual violence, as follows:

1.Direct exposure

2.Witnessing, in person, (especially as the event occurred to primary

caregivers) Note: Witnessing does not include viewing events in electronic
media, television, movies, or pictures.

3.Indirect exposure, learning that a parent or caregiver was exposed

2.Traumatic nightmares in which the content or affect is related to the

traumatic event(s). Note: Its not always possible to determine that the
frightening content is related to the traumatic event.

3.Dissociative reactions (e.g., flashbacks); such trauma-specific re-enactment

may occur in play

B. Presence of one or more intrusion symptoms associated with the traumatic

event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing recollections (which may be
expressed as play)
2. Traumatic nightmares in which the content or affect is related to the traumatic
event(s). Note: Its not always possible to determine that the frightening content is
related to the traumatic event.

3.Dissociative reactions (e.g., flashbacks); such trauma-specific re-enactment may

occur in play

4.Intense or prolonged distress after exposure to traumatic reminders

5.Marked physiological reactions after exposure to trauma-related stimuli

One or more symptoms from either Criterion C or D below:

C. Persistent effortful avoidance of trauma-related stimuli:
1. Avoidance of activities, places, or physical reminders

2. Avoidance of people, conversations, or interpersonal situations

D. Persistent trauma-related negative alterations in cognitions and mood beginning

or worsening after the traumatic event occurred, as evidenced by one or more of
the following:
1. Negative emotional states (e.g., fear, guilt, sadness, shame, confusion)
2. Diminished interest in significant activities, including constriction of play

3. Socially withdrawn behavior

4. Reduced expression of positive emotions

E. Alterations in arousal and reactivity associated with the traumatic event,, as

evidenced by two or more of the following:
1. Irritable behavior and angry outbursts (including extreme temper tantrums)
2. Hypervigilance
3. Exaggerated startle response
4. Problems with concentration
5. Sleep disturbance

F.Duration (of Criteria B, C, D and E) is more than 1 month

G.The symptoms causes clinically significant distress or impairment in

relationships

H.Symptoms are not attributable to a substance (e.g., medication or alcohol) or

medical condition