DSM 5 Posttraumatic Stress Disorder:

Criteria A:

PTSD is caused by trauma resulting from:

  1. direct experience
  2. witnessing in person an event as it happened to someone else,
  3. Learning a traumatic event occurred to close friend or family, or
  4. repeated direct or indirect exposure.

Criteria B: Intrusive symptoms (1 or more)

  1. Recurrent, Involuntary and Intrusive distressing memories and dreams
  2. Dissociative reactions, flashbacks, feelings or acts as if trauma reoccurs
  3. Intense distress and physiological reactions to triggers

Criteria C: Avoidance (1 or both)

  1. Avoidance or effort to avoid distressing memories, thoughts or feelings about a traumatic event
  2. Avoidance or effort to avoid external reminders (activities, objects, situations, etc).

Criteria D. Negative Alternations in Cognition and Mood (2 or more)

  1. Inability to remember aspects of trauma
  2. Persistent and exaggerated negative believes (no one is safe, all people are bad)
  3. Persistent, distorted views about the cause or consequences – Self blame
  4. Persistent negative emotional state (anger, horror, shame, guilt, fearful)
  5. Loss of interest in participation in activities
  6. Feeling detached from others
  7. Persistent inability to experience positive emotions

Criteria E. Alternations of Arousal (1 or more)

  1. Irritable behavior and angry outbursts
  2. Reckless or self-destructive tendencies
  3. Hypervigilance
  4. Exaggerated startle response
  5. Problems with concentration
  6. Sleep disturbances

Criteria F: Length of time

  • 1 month and longer / Here is the distinction between Acute Stress disorder and PTSD. Acute stress disorder is diagnosed when symptoms are 3 days to 1 month. An Other Trauma and Stressor related disorder is diagnosed when not all the criteria are met.

Criteria G: Impairment

  1. Cause distress or impairment in social, occupational or other important function

Criteria H:

  1. Independent of drug, alcohol or injury

Assessment strategies you might utilize to support your diagnosis

Common Assessment strategies

  1. For military personnel is the PTSD Checklist – Military Version (PCL-M) taken from the DSM-IV
  2. For Veterans, the Department of Veteran’s Affairs use VA Form 21-0960P-3 updated May 2018. The form is designed to assist clinicians enter additional information including an individual’s mental health history, injuries, depression, and comorbidity.

Evidence-based treatment interventions for this disorder

Common Evidence-Based Treatments used by the Department of Veteran’s Affairs are:

Cognitive Behavioral Therapy helps change (1) a person’s way of acting, (like smoking less or being more outgoing) (2) way of feeling: like helping a person to be less scared, less depressed, or less anxious (3) A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts (4) A way of dealing with physical or medical problems:

Cognitive Process Therapy (normally used to treat sexual trauma but is becoming more common in treating all forms of PTSD) help’s change thoughts and beliefs about trauma.

Mindfulness Meditation is another method used to treat the anxiety and hypervigilance related to PTSD.

Drug treatment therapy is coupled with psychological treatment. Drugs such as Prazosin are used to treat nightmares and Trazodone is used for sleep.


  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, Virginia: American Psychiatric Association Publishing
  • American Psychiatric Association. (2019). Online Assessment Measures. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures#Level2
  • Department of Veteran Affairs. (2017). VA Form 21-0960P-3. Retrieved from: https://www.va.gov.vaforms/form_detail.asp?FormNo=21-0960P-3
  • National Center for Post-Traumatic Stress Disorder & Walter Reed Army Medical Center. (2004). Iraq War Clinician Guide, 2nd edition. United States: Department of Veterans Affairs & National Center for PTSD
  • Ray, W.J. (2018). Abnormal Psychology, 2nd edition. Thousand Oaks, California: Sage
  • Uniformed Services University & Center for Deployment Psychology. (2019). PTSD Checklist-Military Version (PCL-M). Retrieved from: https://deploymentpsych.org/system/files/member_resource/4-PCL-M.pdf

Additional Resources:

Ackerman, C. E. (2019). 25 CBT Techniques and Worksheets for Cognitive Behavioral Therapy. Positive psychology.com Retrieved from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets

American Psychological Association. (2019). Ethical Principles of Psychologists and Code of Conduct. Retrieved from https://www.apa.org/ethics/code/index

Barash, D. P. (2005). B.F. skinner, revisited. The Chronicle of Higher Education, 51(30), B10-B11. Retrieved from http://proxy1.calsouthern.edu/login?url=https://search-proquest-com.proxy1.calsouthern.edu/docview/214678007?accountid=35183

Barzilay, R., Calkins, M. E., Moore, T. M., Wolf, D. H., Satterthwaite, T. D., Cobb Scott, J., … Gur, R. E. (2019). Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort. Psychological Medicine, 49(2), p. 325–334. https://doi.org/10.1017/S0033291718000880

Bergland, C. (2016). How Does Anxiety Short Circuit the Decision-Making Process? Anxiety disengages neurons in the prefrontal cortex linked to decision-making. Psychology Today: Retrieved From https://www.psychologytoday.com/us/blog/the-athletes-way/201603/how-does-anxiety-short-circuit-the-decision-making-process

Brewin, C. (2013). Posttraumatic Stress Disorder and the Brain. J Neurol Neurosurg Psychiatry, 84(1). p. 1 – 15. DOI. 10.1136/jnnp-2013-306103.3

Burhans, L. B., Smith-Bell, C. A., & Schreurs, B. G. (2015). Effects of extinction treatments on the reduction of conditioned responding and conditioned hyperarousal in a rabbit model of posttraumatic stress disorder (PTSD). Behavioral Neuroscience, 129(5), p. 611–620. https://doi.org/10.1037/bne0000092

Carlson, N. R. (2013). Physiology of Behavior (11th ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.

Cantelon, J. A., Giles, G. E., Eddy, M. D., Haga, Z., Mahoney, C. R., Taylor, H. A., & Davis, F. C. (2019). Exerting cognitive control under threat: Interactive effects of physical and emotional stress. Emotion, 19(7), p. 1236–1243. https://doi.org/10.1037/emo0000509

Campillo, E., Ricarte, J. J., Ros, L., Nieto, M., & Latorre, J. M. (2018). Effects of the Visual and Auditory Components of a Brief Mindfulness Intervention on Mood State and on Visual and Auditory Attention and Memory Task Performance. Current Psychology, (1), 357. https://doi.org/10.1007/s12144-016-9519-y

Carrion, V. G. & Weems, C. F. (2017). Neuroscience of Pediatric PTSD. New York, New York: Oxford University Press

Chen, Y. R., Hung, K. W., Tsai, J. C., Chu, H., Chung, M. H., Chen, S. R., Liao, M… & Chou, K. R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: a meta-analysis of randomized controlled trials. PLoS ONE, (8), e103676. https://doi.org/10.1371/journal.pone.0103676

Corliss, J. (2019). Six Relaxation Techniques to Reduce Stress. Harvard Heath Publishing. Retrieved from https://www.health.harvard.edu/mind-and-mood/six-relaxation-techniques-to-reduce-stress

Crisp, R. (2014). Characteristics of master therapists and the influence of Carl Rogers: A discussion. Counselling Psychology Review, 29(3), 55–64. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=97763955&site=eds-live&scope=site

Cross, S. E., Gore, J. S., & Morris, M. L. (2003). The relational-interdependent self-construal, self-concept consistency, and well-being. Journal of Personality and Social Psychology, 85(5), 933-944. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1037/0022-3514.85.5.933

Cummings, J. L. & Mega, M. S. (2003). Neuropsychiatry and Behavioral Neuroscience. New York, New York: Oxford University Press.

Cwik, J., Sartory, G., Nuyken, M., Schürholt, B., & Seitz, R. (2017). Posterior and prefrontal contributions to the development posttraumatic stress disorder symptom severity: an fMRI study of symptom provocation in acute stress disorder. European Archives of Psychiatry & Clinical Neuroscience, 267(6), p. 495–505. https://doi.org/10.1007/s00406-016-0713-6

Dahlgren, M. K., Laifer, L. M., VanElzakker, M. B., Offringa, R., Hughes, K. C., Staples-Bradley, L. K., … Shin, L. M. (2018). Diminished medial prefrontal cortex activation during the recollection of stressful events is an acquired characteristic of PTSD. Psychological Medicine, 48(7), p. 1128–1138. https://doi.org/10.1017/S003329171700263X

DeRobertis, E. M. (2016). On framing the future of humanistic psychology. The Humanistic Psychologist, 44(1), p. 18–41. https://doi.org/10.1037/hum0000014

Ekman, P., & Davidson, R. J. (1993). Voluntary Smiling Changes Regional Brain Activity. Psychological Science (0956-7976), 4(5), p. 342–345. https://doi.org/10.1111/j.1467-9280.1993.tb00576.x

Ekman, P., Roper G. & Hager, J. C. (1980). Deliberate Facial Movement. Child Development, 51(3), 886. https://doi.org/10.2307/1129478

Farber, B. A., Suzuki, J. Y., & Lynch, D. A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4), p. 411–423. https://doi.org/10.1037/pst0000171

Finkelstein C, Brownstein A, Scott C, & Lan YL. (2007). Anxiety and stress reduction in medical education: an intervention. Medical Education, 41(3), p. 258–264. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=106010863&site=eds-live&scope=site

Flanagan, J. C., Hand, A., Jarnecke, A. M., Moran-Santa Maria, M. M., Brady, K. T., & Joseph, J. E. (2018). Effects of oxytocin on working memory and executive control system connectivity in posttraumatic stress disorder. Experimental and Clinical Psychopharmacology, 26(4), p. 391–402. https://doi.org/10.1037/pha0000197

Forster, S., Nunez Elizalde, A. O., Castle, E., & Bishop, S. J. (2013). Unraveling the Anxious Mind: Anxiety, Worry, and Frontal Engagement in Sustained Attention Versus Off-Task Processing. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edssch&AN=edssch.oai%3aescholarship.org%2fark%3a%2f13030%2fqt2c16n293&site=eds-live&scope=site

Howard, J. L., Gagné, M., & Bureau, J. S. (2017). Testing a continuum structure of self-determined motivation: A meta-analysis. Psychological Bulletin, 143(12), p. 1346–1377. http://dx.doi.org/10.1037/bul0000125

John S., I. (2004). Numerical Distraction Therapy: Initial Assessment of a Treatment for Posttraumatic Stress Disorder. Traumatology, (1), p. 39. https://doi.org/10.1177/153476560401000104

Kessler, H., Holmes, E. A., Blackwell, S. E., Schmidt, A.-C., Schweer, J. M., Bücker, A., … Kehyayan, A. (2018). Reducing intrusive memories of trauma using a visuospatial interference intervention with inpatients with posttraumatic stress disorder (PTSD). Journal of Consulting and Clinical Psychology, 86(12), p. 1076–1090. https://doi.org/10.1037/ccp0000340

Kida, S. (2019). Reconsolidation/destabilization, extinction and forgetting of fear memory as therapeutic targets for PTSD. Psychopharmacology, 236(1), p. 49–57. https://doi.org/10.1007/s00213-018-5086-2

Koritar, E. (2016). Relaxation in technique leading to new beginnings. The American Journal of Psychoanalysis, (4), 341. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgih&AN=edsgcl.486699916&site=eds-live&scope=site

Labrecque, L. I., & Milne, G. R. (2012). Exciting red and competent blue: the importance of color in marketing. Journal of the Academy of Marketing Science, (5), 711. https://doi.org/10.1007/s11747-010-0245-y

Li, H., Li, X., Smerin, S.E., Zhang, L., Jia, M., Xing, G., Su, Y.A., Wen, J., Benedek, D. & Ursano, R. (2014). Mitochondrial Gene Expression Profiles and Metabolic Pathways in the Amygdala Associated with Exaggerated Fear in an Animal Model of PTSD. Frontier in Neurology, 5(164). p. 1-15. DOI: 10.3389/fneur.2014.00164

Liu, J., Subramaniam, M., Chong, S. A., & Mahendran, R. (2019). A systematic examination of cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight in relation to posttraumatic stress disorder symptoms among trauma exposed patients with early nonaffective psychosis. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0000531.supp (Supplemental)

Lobo, I., de Oliveira, L., David, I. A., Pereira, M. G., Volchan, E., Rocha-Rego, V., Figueira, I & Mocaiber, I. (2011). The neurobiology of posttraumatic stress disorder: Dysfunction in the prefrontal-amygdala circuit? Psychology & Neuroscience, 4(2), p. 191–203. https://doi.org/10.3922/j.psns.2011.2.004

Mantua, J., Helms, S. M., Weymann, K. B., Capaldi, V. F. & Lim, M. M. (2018). Sleep Quality and Emotion Regulation Interact to Predict Anxiety in Veterans with PTSD. Behavioural Neurology. https://doi.org/10.1155/2018/7940832

Maycock, G. (1988). The Three-Fingers Technique: Does It Reduce Test Anxiety? Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=ED318750&site=eds-live&scope=site

McLay, R. N., Webb-Murphy, J. A., Fesperman, S. F., Delaney, E. M., Gerard, S. K., Roesch, S. C., … Johnston, S. L. (2016). Outcomes from eye movement desensitization and reprocessing in active-duty service members with posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), p. 702–708. https://doi.org/10.1037/tra0000120

Montag, C., & Panksepp, J. (2016). Primal emotional-affective expressive foundations of human facial expression. Motivation & Emotion, 40(5), p. 760–766. https://doi.org/10.1007/s11031-016-9570-x

Nardo, D., Högberg, G., Jonsson, C., Jacobsson, H., Hällström, T., & Pagani, M. (2015). Neurobiology of Sleep Disturbances in PTSD Patients and Traumatized Controls: MRI and SPECT Findings. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2015.00134

Nicholson, A. A., Rabellino, D., Densmore, M., Frewen, P. A., Paret, C., Kluetsch, R., Schmahl, C., Theberge, J., Newfelt, R. W. J., McKinnon, M. C., Reiss, J., Jetly, R. & Lanius R. A. (2017). The Neurobiological of Emotion Regulation in Posttraumatic Stress Disorder: Amygdala Downregulation Via Real-Time fMRI Neurofeedback. Human Brain Mapping, 38(). p. 541-560. DOI: https://doi.org/10.1002/hbm.23402

Nomura, M., Takahashi, T., Kamijo, K., & Yamazaki, T. (2000). A new adaptive temporal filter: Application to photosensitive seizure patients. Psychiatry & Clinical Neurosciences, 54(6), p. 685–690. https://doi.org/10.1046/j.1440-1819.2000.00770.x

Padesky, C. A., & Mooney, K. A. (2012). Strengths-Based Cognitive-Behavioural Therapy: A Four-Step Model to Build Resilience. Clinical Psychology & Psychotherapy, 19(4), p. 283–290. https://doi.org/10.1002/cpp.1795

Park, J. & Moghaddam, B. (2017).Impact of Anxiety on Prefrontal Cortex Encoding of Cognitive Flexibility. Neuroscience, p. 193-202. DOI:10.1016/j.neuroscience.2016.06.013

Pelet, J.-É., & Papadopoulou, P. (2012). The effect of colors of e-commerce websites on consumer mood, memorization and buying intention. European Journal of Information Systems, 21(4), p. 438–467. https://doi.org/10.1057/ejis.2012.17

Perez, D. L., Matin, N., Barsky, A., Costumero-Ramos, V., Makaretz, S. J., Young, S. S., … Dickerson, B. C. (2017). Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders. Journal of Neurology, Neurosurgery and Psychiatry, (6), 491. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.511526495&site=eds-live&scope=site

Qingzhen, L., Jiehua, M., Zhiyang, Y., Hongjun, L., Chunlong, C., & Weiyan, L. (2016). Distinct hippocampal expression profiles of lncRNAs in rats exhibiting a PTSD-like syndrome. Molecular Neurobiology, 53(4), p. 2161-2168. DOI: 10.1007/s12035-015-9180-8

Ray, W.J. (2018). Abnormal Psychology, 2nd edition. Thousand Oaks, California: Sage

Reeve, J. (2018). Understanding Motivation and Emotion, 11th ed. Hoboken, New Jersey: John Wiley& Sons, Inc.

Rho, J. M. & Storey, T. W. (2000). Molecular Ontogeny of Major Neurotransmitter Receptor Systems in the Mammalian Central Nervous System: Norepinephrine, Dopamine, Serotonin, Acetylcholine, and Glycine. Irvine, California: University of California

Robinson, L., Segal, R., Segal, M. & Smith, M. (2019). Relaxation Techniques for Stress Relief. HelpGuide. Retrieved from https://www.helpguide.org/articles/stress/relaxation-techniques-for-stress-relief.htm

Rodriguez, S. N., & Loos-Sant’Ana, H. (2015). Self-concept, self-esteem and self-efficacy: the role of self-beliefs in the coping process of socially vulnerable adolescents. The Journal of Latino-Latin American Studies, (1), 33. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.490820284&site=eds-live&scope=site

Ruff, C. C., & Fehr, E. (2014). The neurobiology of rewards and values in social decision making. Nature Reviews Neuroscience, (8), 549. https://doi.org/10.1038/nrn3776

Rudolph, K. D., Troop-Gordon, W., & Llewellyn, N. (2013). Interactive contributions of self-regulation deficits and social motivation to psychopathology: Unraveling divergent pathways to aggressive behavior and depressive symptoms. Development & Psychopathology, 25(2), p. 407–418. https://doi.org/10.1017/S0954579412001149

Sallon, S., Katz-Eisner, D., Yaffe, H., & Bdolah-Abram, T. (2017). Caring for the Caregivers: Results of an Extended, Five-component Stress-reduction Intervention for Hospital Staff. Behavioral Medicine, 43(1), p. 47–60. https://doi.org/10.1080/08964289.2015.1053426

Sanda, D., Yifan, H., Alexandru D., I., Matthew, M., & Florin, D. (2016). Optimism and the brain: trait optimism mediates the protective role of the orbitofrontal cortex gray matter volume against anxiety. Social Cognitive and Affective Neuroscience, (2), 263. https://doi.org/10.1093/scan/nsv106

Shefer, N., Carmeli, A., & Cohen-Meitar, R. (2018). Bringing Carl Rogers Back In: Exploring the Power of Positive Regard at Work. British Journal of Management, (1), 63. https://doi.org/10.1111/1467-8551.12247

Shapiro, R., & Brown, L. S. (2019). Eye movement desensitization and reprocessing therapy and related treatments for trauma: An innovative, integrative trauma treatment. Practice Innovations, 4(3), p. 139–155. https://doi.org/10.1037/pri0000092

Soldat, A. S., & Sinclair, R. C. (2001). Colors, smiles, and frowns: external affective cues can directly affect responses to persuasive communications in a mood-like manner without affecting mood. Social Cognition, (4), 469. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.86143833&site=eds-live&scope=site

Swann, W. B., Jr., Chang-Schneider, C., & McClarty, K. L. (2007). Do people’s self-views matter? Self-concept and self-esteem in everyday life. The American Psychologist, 62(2), p. 84-94. DOI: 10.1037/0003-066X.62.2.84

University of Washington. (2017). How to Reduce Stress Through Mindfulness. Retrieved from: http://agerrtc.washington.edu/info/factsheets/mindfulness

Uvnäs-Moberg, K., Handlin, L. & Petersson, M. (2015). Self-Soothing Behaviors With Particular Reference to Oxytocin Release Induced by Non-Noxious Sensory Stimulation. Frontier in Psychology, 4(1529), p. 1-16. DOI: 10.3389/fpsyg.2014.01529

Valdez, P., & Mehrabian, A. (1994). Effects of color on emotions. Journal of Experimental Psychology: General, (4), 394. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.16475968&site=eds-live&scope=site

Van Der Kolk, B. A. (2001). The psychobiology and psychopharmacology of PTSD. Human Psychopharmacology: Clinical & Experimental, 16, p. S49–S64. https://doi.org/10.1002/hup.270

Villena-González, M., López, V., & Rodríguez, E. (2016). Orienting attention to visual or verbal/auditory imagery differentially impairs the processing of visual stimuli. NeuroImage, 132, p. 71-78. Retrieved from http://dx.doi.org/10.1016/j.neuroimage.2016.02.013