Posttraumatic Stress Disorder (PTSD) Diagnosis and Symptoms

Diagnostic Criteria

The American Academy of Pediatrics recommends that Acute Stress Disorder (ASD) requires symptoms occurring between 3 days to 1 month after traumatic exposure 1, 2
The American Academy of Pediatrics suggests that PTSD requires symptoms that persist for ≥1 month (or ≥3 months in some definitions) after the trauma 1, 2, 3
Symptoms persisting for ≥1 month after the trauma meet the criteria for PTSD, regardless of the symptom profile 1, 2

The American Academy of Pediatrics notes that PTSD symptom clusters include intrusive symptoms, such as intrusive flashbacks (reexperiencing the traumatic event) 1, 3
The American Academy of Pediatrics states that PTSD symptom clusters also include dissociative symptoms, such as numbness and derealization (loss of awareness of present surroundings, feeling that things are unreal) 1, 3
Significant distress, marked by functional impairment, is a key component of PTSD symptoms 3

The American Academy of Pediatrics recommends ruling out Acute Stress Disorder because the 1-month window has passed, and ASD specifically captures the acute phase (3 days to 1 month post-trauma) 1, 2
The American Psychiatric Association suggests that Panic Disorder is not appropriate because the symptoms are clearly trauma-linked and include dissociative and intrusive reexperiencing phenomena, not just discrete panic attacks with autonomic arousal 4
The American Academy of Pediatrics notes that Phobia is incorrect because the patient is experiencing intrusive flashbacks and dissociation related to a specific traumatic event, not an irrational fear of a specific object or situation that leads to avoidance behavior 3

The American Academy of Pediatrics identifies dissociative symptoms such as numbness and derealization as core PTSD symptom clusters, which are strongly correlated with the development of PTSD, especially when peritraumatic dissociation is present 5, 6, 7

Trauma-focused psychotherapy remains first-line treatment for PTSD and should not be delayed, even in patients with dissociative symptoms, as the evidence does not support that trauma-focused treatments pose significant risks, according to the guidelines from the American Psychological Association 5, 6, 7