Clinical Psychology
and Psychotherapy

Clinical Psychology and Psychotherapy

Posttraumatic Stress Disorder (PTSD):
Diagnosis according to DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists the Posttraumatic Stress Disorder (PTSD) (DSM-IV 309.81) as an anxiety disorder. Since this classification is rather unfortunate, there are moves to provide a separate category for those disorders that occur as a stress reaction.

Previous to the onset of the PTSD there must be a traumatizing event, which involved the actual or threatened death, serious injury or threat to physical integrity of oneself or others.

The traumatic event may have affected the patient directly or it has been witnessed by him as it happened to others. According to the DSM-IV, the patient must have shown intense fear, helplessness or anxiety in response to the traumatic event The condition must persist for at least a month.

The diagnosis requires, that patients suffer from an ongoing re-experiencing of the traumatic event (through recurring, haunting, stressful memories of the event and / or images, thoughts or perceptions, and / or by recurrent, distressing dreams of the event and / or action and feeling as if the traumatic event were recurring and / or by intense psychological distress at exposure to internal or external cues that symbolize an aspect of the traumatic event, or resemble him).

The patients try to avoid possible triggering stimuli associated with the trauma, and / or suffer from a slowdown in general responsiveness, which in this form was not present before the traumatic event. Additionally, the DSM-IV requires that the patients suffer from at least 3 of the following symptoms:

  • Efforts to avoid thoughts, feelings or conversations associated with the trauma.
  • Efforts to avoid activities, places or people that arouse recollections of the trauma.
  • Inability to recall an important aspect of the trauma.
  • Significantly diminished interest or participation in significant activities.
  • Feeling of detachment or estrangement from others.
  • Restricted range of affect (eg. being unable to experience love).
  • Sense of a foreshortened future (eg. the expectation, not to have a career, marriage, children or a normal life).

Those affected suffer from hyperexcitability associated with an increased level of arousal, that in this form was not present prior to the traumatic event, and that results in insomnia, irritability or outbursts of anger, difficulty concentrating and / or excessive vigilance.

In addition, according to DSM-IV the disorder must cause "clinically significant distress or impairment in social, occupational or other important areas of functioning."

The DSM-IV further subdivides into acute PTSD, with less than three months of duration,  chronic PTSD (duration of three months or longer) and a PTSD with delayed onset (beginning no earlier than six months after the trauma).

© Sandra Elze, M.D. & Michael Elze, M.D.
Prien am Chiemsee / Rosenheim,


Further Reading...



PTSD: Guidelines

Flatten G, Gast U, Hofmann A, Knaevelsrud Ch, Lampe A et al. (2011). S3 - Leitlinie Posttraumatische Belastungsstörung. Trauma & Gewalt 3: 202-210.

National Institute for Clinical Excellence - NICE (2005): Post-traumatic stress disorder (PTSD). London: NICE (Clinical Guideline 26).



© Sandra Elze, M.D. & Michael Elze, M.D.
Prien am Chiemsee / Rosenheim,



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© Sandra Elze, M.D. & Michael Elze, M.D.
Prien am Chiemsee / Rosenheim,
Last updated: 03-24-2016

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