Table 1.

DSM-IV Criteria for PTSD Showing Alternative Algorithm Changes

Diagnostic criteria for Posttraumatic Stress Disorder
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 (No change from DSM-IV).
B. The traumatic event is persistently re-experienced 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 or repetitive behaviors may occur in which themes or aspects of the trauma are expressed. Furthermore, recollections may appear not to be distressing in young children.
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. Persistence avoidance of stimuli associated with the trauma and numbing of responsiveness (not present before the trauma), as indicated by three one or more of he 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. Note: In young children, this may be manifest as constriction in play.
5. feeling of detachment or estrangement from others (e.g., unable to have loving feelings). Note: In young children this may be manifest as social withdrawal.
6. restricted range of affect.
7. sense of 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, or extreme temper tantrums in young children.
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.