How PTSD Is Diagnosed

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Post-traumatic stress disorder (PTSD) is a mental health condition that develops after a person experiences a shocking, terrifying, or overwhelming event. PTSD symptoms usually begin within three months of the traumatic incident, but sometimes they begin years afterward. 

Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. It’s important that those who suspect that they have PTSD work with a mental health provider who’s experienced in PTSD to get an accurate diagnosis and appropriate treatments.

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Professional Screenings

The initial screening is done by a primary care physician. Then they may refer their patient to a licensed mental health professional, who can provide an official diagnosis of PTSD. An initial screening may involve questions about emotional states, sleep issues, and anger, as well as lab tests to rule out physical conditions that could be causing PTSD symptoms.

A mental health professional will use the diagnostic criteria in The Diagnostic and Statistical Manual, 5th Edition (DSM-5) to determine whether a person has PTSD. Symptoms of PTSD fall into four categories:

  • Intrusion: Intrusive thoughts can include recurrent, involuntary memories; distressing dreams; and flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes.
  • Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects, and situations that may trigger distressing memories, thoughts, or feelings associated with the trauma. They may also resist talking about what happened or how they feel about it.
  • Alterations in cognition and mood: This encompasses an inability to remember important aspects of the traumatic event, negative thoughts, and feelings, leading to ongoing and distorted beliefs about oneself or others; distorted thoughts about the cause or consequences of the event, leading to wrongly blaming self or others; ongoing fear, horror, anger, guilt, or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions.
  • Alterations in arousal and reactivity: These symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in an overly vigilant way; being easily startled; or having problems concentrating or sleeping.

To be diagnosed with PTSD, an adult must have all of the following for at least one month:

  • At least one intrusion symptom
  • At least one avoidance symptom
  • At least two cognition and mood symptoms
  • At least two arousal and reactivity symptoms

These symptoms must also cause significant distress or problems in the individual’s daily functioning.

Symptoms of PTSD in children and teens may not be the same as in adults. In addition to typical symptoms of PTSD, children may have regression such as wetting the bed after having learned to use the toilet, being unable to talk, acting out the scary event during playtime, and being unusually clingy with a parent or another adult.

Tests

A number of assessment tools are used to diagnose PTSD.

CAPS-5

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a standard test used to diagnose PTSD. This is a 30-item questionnaire that clinicians use to better understand the patient’s experience with PTSD.

The goal of CAPS-5 is to establish whether a person can be diagnosed with PTSD. It is also used to assess whether this condition has been present throughout a person’s life or within the past month. Additionally, this assessment is used to assess symptoms as the patient has experienced them over the previous week. 

Specifically, these questions explore:

  • The onset and duration of symptoms
  • The impact of symptoms on social relationships and work functioning
  • Overall severity of PTSD symptoms
  • Presence of dissociative subtype, like depersonalization and derealization

This interview takes roughly an hour to complete, follows a detailed scoring system, and determines to what extent the severity of the symptoms impacts an individual’s daily life. 

Treatment-Outcome Post Traumatic Stress Disorder Scale (TOP-8)

The TOP-8 is also an interview-based assessment tool that uses the DSM-5 to understand and evaluate symptoms. This scale includes eight questions drawn from the core symptom groups associated with PTSD, which include intrusion, avoidance, and numbing. 

PTSD Symptom Scale Interview (PSS-I and PSS-I-5)

The PSS-I is a 17-item assessment tool that asks patients to identify a singular traumatic event that they believe is causing their symptoms. Symptoms from the past two weeks are identified and assessed as they relate to the DSM-5 diagnosis criteria.

The PSS-I-5 contains 24 questions, with 20 focusing on symptoms and four focusing on symptom distress, interference, onset, and duration.

Self/At-Home Testing

A person who thinks they may have PTSD can also assess their symptoms using a number of at-home tests. However, it’s important to remember that only a licensed mental health professional can make a diagnosis of PTSD.

The Davidson Trauma Scale (DTS)

The Davidson Trauma Scale (DTS) is a self-assessment that people can use to screen themselves for PTSD. This test uses a four-item scale called SPAN that looks at four key areas involved in PTSD: startle, physiological arousal, anger, and emotional numbness. This test has 17 items and asks the person taking it to rate the severity of each symptom across the SPAN categories.

PTSD Checklist for DSM-5 (PCL-5)

Patients can also use the PTSD Checklist for DSM-5, or PCL-5, to assess their symptoms. Composed of 20 questions, this report was created by the National Center for PTSD of the Department of Veterans Affairs and is used widely because it can offer support throughout a person’s PTSD journey.

In addition to supporting self-assessment with PTSD, it can also be used after a diagnosis to monitor symptoms. Therefore, it acts both as a tool for diagnosis and one for assessing symptoms to understand improvement.

Short PTSD Rating Interview (SPRINT)

The Short PTSD Rating Interview, or SPRINT, can be used to assess main PTSD symptoms. It looks at eight proven PTSD symptom categories, including intrusion, avoidance, numbing, arousal, somatic malaise, stress vulnerability, and role and social impairment.

This assessment is best used when a person is first interested in seeking care for PTSD, and it is considered a more preliminary approach for people who aren’t sure whether they have PTSD. The test uses a five-point scale, asking patients to rank their symptoms from 0 to 4. If a person’s results are positive, meaning they rated at least one question above 0, they need further assessment by a professional.

PTSD Subtypes

Recent research suggests that there may be four main subtypes of PTSD. The goal of differentiating these is to allow a better understanding of treatment methods and how different subtypes better respond to unique treatments.

This research outlines the following subtypes:

  • Dysphoric, which involves intrusive thoughts, negative emotions and depressed feelings, anxiety, isolation, and difficulty with sleep and concentration
  • Threat, which involves a higher rate of re-experiencing the causal event, along with negative emotions, self-blame, and hyperarousal
  • High symptom, which involves high levels of all symptoms (minus amnesia and high-risk behavior), plus higher rates of anxiety, depression, substance abuse, and other mental health disorders
  • Low symptom, which involves low levels of all symptoms (minus intrusive thoughts, negative emotions, and hyper vigilance) and better physical and emotional health

A Word From Verywell

If you or a loved one is experiencing symptoms that may be related to PTSD, it can be stressful. However, understanding the many different tests available for your diagnosis is the first and most important step in getting the help you need.

Remember that only a licensed professional can diagnose PTSD. If you’ve completed a questionnaire that suggests you may have PTSD, a clinician experienced in PTSD is ready and willing to help.

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