Posttraumatic Stress Disorder
- The patient has experienced or witnessed or was confronted with an unusually traumatic event that has both of these elements:
The event involved actual or threatened death or serious physical injury to the patient or to others, and
The patient felt intense fear, horror or helplessness*
- The patient repeatedly relives the event in at least 1 of these ways:
-Intrusive, distressing recollections (thoughts, images)*
-Repeated, distressing dreams*
-Through flashbacks, hallucinations or illusions, acts or feels as if the event were recurring (includes experiences that occur when intoxicated or awakening)*
-Marked mental distress in reaction to internal or external cues that symbolize or resemble the event.
-Physiological reactivity (such as rapid heart beat, elevated blood pressure) in response to these cues
- The patient repeatedly avoids the trauma-related stimuli and has numbing of general responsiveness (absent before the traumatic event) as shown by 3 or more of:
-Tries to avoid thoughts, feelings or conversations concerned with the event
-Tries to avoid activities, people or places that recall the event
-Cannot recall an important feature of the event
-Marked loss of interest or participation in activities important to the patient
-Feels detached or isolated from other people
-Restriction in ability to love or feel other strong emotions
-Feels life will be brief or unfulfilled (lack of marriage, job, children)
- At least 2 of the following symptoms of hyperarousal were not present before the traumatic event:
-Insomnia (initial or interval)
-Irritability
-Poor concentration
-Hypervigilance
-Increased startle response
- The above symptoms have lasted longer than one month.
- These symptoms cause clinically important distress or impair work, social or personal functioning.
Specify whether:
Acute. Symptoms have lasted less than 3 months
Chronic. Symptoms have lasted 3 months or longer
Specify if:
With Delayed Onset. The symptoms did not appear until at least 6 months after the event.
Coding note
*In children, response to the traumatic event may be agitation or disorganized behavior. Young children may relive the event through repetitive play, trauma-specific reenactment or nightmares without recognizable content.
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
(cautionary statement)
A. The person has been exposed to a traumatic event in which both of the following were present:
(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. Note: In children, this may be expressed instead by disorganized or agitated behavior
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(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). Note: In young children, trauma-specific reenactment may occur.
(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
C. 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:
(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 (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor
