Thoughts From This Therapist: PTSD The Diagnosis
The works in this series will always be the opinion of the writer (me, Rebecca). Therapy and healing is not a one-size-fits-all box, so keep that in mind when reading. Everything in this series will come from my experiences both as a therapist and patient. I hope it gives you insight into different perspectives, and gives me a place to share thoughts on topics I feel are important. Enjoy!
Trigger Warning: This post discusses PTSD and trauma. Although it is an overview of the diagnostic criteria there is still the possibility of being triggered. It is completely alright for you to not read this right now or to take a break while reading this.
NOTE: This writing is not intended to be used for self diagnoses. All diagnosing should be done by a trained professional. The information being provided is just for your personal knowledge and understanding.
PTSD is a term that is heard frequently these days. I will explore with you the technical terms and criteria for PTSD; where they come from and how it is used in mental health treatment. The hope is to give you a better understanding of why some individuals get diagnosed and others don’t.
Ok PTSD what is it? Posttraumatic Stress Disorder is what it stands for. The APA (American Psychiatric Association) has determined specific criteria that one has to meet in order to be diagnosed with PTSD. This criteria can be found in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). I will be referencing the DSM-5 for the criteria that providers use for diagnosing.
PTSD is in the chapter of the DSM-5 called “Trauma and Stress Related Disorders”. In this chapter you can find: Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Adjustment Disorders, Other Specified Trauma and Stressor Related Disorder and Unspecified Trauma and Stressor Related Disorder. Although there are many disorders associated with trauma we will be focusing on the most common: Posttraumatic Stress Disorder.
Honestly PTSD is a lot like what it sounds like: you develop it only after you have been exposed to a traumatic event. This exposure can be direct exposure or secondary through witnessing it happen to someone else or even hearing about another person’s traumatic experience. One of the key factors in diagnosing though according to the APA is that at least 1 month must have passed since the event and you are still experiencing symptoms.
What are those symptoms? Well they can come in different forms. Intrusive symptoms; as the DSM-5 calls them; include having memories come up that are unwanted and relate to the experience, possibly having dreams or nightmares about the experience, having flashbacks or other dissociative experiences; feeling strongly distressed at things related to the traumatic event both physically and psychologically.
Along with the intrusive symptoms you can also experience wanting to avoid anything and everything that could remind you of the traumatic experience. It is also likely that you will experience cognitive changes such as being more negative about yourself and others; self blame for the event, not being able to remember everything that happened, feeling some depression and/or anxiety, not feeling connected to others and not being able to experience positive emotions. Most likely you will also possibly experience being angry all the time and having outbursts.
As if all of those things are not enough let’s wrap up the symptoms with some of the most common that we are aware of. Being easily startled and always on guard are super common especially for those who have experienced any type of psychical trauma. Having trouble concentrating and sleeping are both common as well. Finally even with all of the above symptoms mentioned there is also the criteria that the symptoms must cause “significant distress or impairment in social, occupational or other important areas of functioning” (pg272).
There are other specifications that are to be considered for professionals as well but the above discusses the main criteria. I would also like to note that the criteria for children under 6 is also slightly different and has their section following the main PTSD criteria. However, at this time I do not feel it is necessary to walk you through that information.
While we use the diagnostic criteria in the DSM-5 to help us make diagnosis we also have screening tools that we use. The most common is the PCL (PTSD Checklist) and there are multiple different version. The one I use most frequently is the Civilian version which you can find here: https://www.bu.edu/wheelock/files/2018/05/PTSD-checklist-Adult.pdf if you are interested. If you look through the questionnaire you can see how the questions are directly related to the criteria listed in the DSM-5.
In looking at all the diagnostic criteria you can see that there is a lot to keep in mind when exploring whether or not to diagnose someone with PTSD. Please note that although there are a lot of criteria, someone who has PTSD may experience their symptoms slightly differently; I will discuss this in future writings. I want to end by saying too that just because someone experiences a traumatic event that doesn't necessarily mean they will develop PTSD.
Having the diagnosis allows professionals to bill insurance companies and provide documentation for specific needs of the client. Knowing which symptoms make up the diagnosis for the client helps guide professionals with the treatment styles they use in sessions. There is also an understanding of how to help clients avoid their triggers based on the information provided until they are able to decrease the impact those triggers have on them.
Understanding PTSD and how to treat it is necessary in the world we live in today. It is very helpful for everyone to understand what PTSD is and how to support themselves and their loved ones if this is something that impacts them. Understanding is the first step in healing.
Do you have any questions or comments about PTSD? I’d love to hear your thoughts. Let me know by leaving a comment below or tagging us on social media (@therapeutichealingjourney on Instagram and @llctherapeutic on Twitter).