How is a PTSD diagnosis made?

It is time to seek help if after a traumatic event:

• Upsetting (or disturbing) thoughts occur frequently and seem uncontrollable (for longer than one month)
• Upsetting and disturbing thoughts are severe
• A person is incapable of living a normal lifestyle
• A person is unable to control negative actions
• A person becomes fearful of harming themselves (may be suicidal) or others

What should a person experiencing these things do?

• Reach out to a trustworthy loved one or close friend for support
• Make an appointment with a mental healthcare professional (psychiatrist or psychologist)

Diagnosis and tests

Once at a mental healthcare professional’s office for a consultation, the doctor will assess a person’s condition based on a thorough evaluation of symptoms. There is no specific diagnostic test for diagnosing PTSD.

A diagnosis for PTSD symptoms will often be based on the following:

• A person experiences as least one ‘re-experience’ symptom for at least 1 month.
• A person experiences as least one ‘avoidance behaviour’ symptom for at least 1 month.
• A person experiences as least two (each) ‘reactive or arousal, and mood change behaviour’ symptoms for at least 1 month.

Using these factors, a psychologist or psychiatrist will be able to rule out other serious symptoms following a dangerous event that typically relate to acute stress disorder (ASD) and resolve within a few weeks. Other factors include a notable effect on a person ability to function normally, which is not as a result of another medical illness, substance abuse or anything unrelated to the event itself. If all other possible conditions and factors are ruled out, a doctor may be inclined to make a diagnosis of PTSD.

The effects of a traumatic event can be directly experienced, witnessed or learned about from an individual close to an affected person. Thus, a person with PTSD need not have experienced a trauma first-hand in order to display symptoms.

Generally, a diagnosis for PTSD will only be made around one month following a traumatic event and as mentioned, involves specially designed assessment tools to evaluate various anxiety-related disorders. If a person presents symptoms and consults a doctor sooner, he or she may offer treatment while assessing the severity of possible PTSD and depressive symptoms before a conclusive diagnosis is made.

At the initial consultation, following a complete medical history and symptoms discussion (and the events that led up to them), a physical exam may be recommended (either by the evaluating professional or the patient will be referred to a general practitioner / GP).

If necessary, during the physical check-up a doctor may request tests to ensure that no symptoms have arisen as a result of a physical condition or medication use. These tests will depend on the physical condition of the individual.

How is post-traumatic stress disorder measured?

Evaluations for PTSD can vary. Some may be done in as little as 15 minutes, and others up to an hour long. A thorough assessment will involve structured questions (Clinician-Administered PTSD Scale [CAPS] or Structured Clinical Interview for DSM [SCID]) and completed surveys regarding thoughts and emotions. A loved one, such as a family member or spouse may be asked to attend a consultation of their own to provide any other relevant information, and assist with an assessment.

Other types of structured interviews and questions a mental health professional may make use of include:

• ADIS (anxiety disorders interview schedule-revised)
• SI-PTSD (structured interview for PTSD)
• PSS-I (PTSD symptom scale interview)
• PTSD interview

Each evaluation has a set structure of questions to assist a mental health professional with making the most appropriate diagnosis.

What type of questions will be asked to assess whether any further evaluation is necessary?

• What kinds of symptoms are being experienced or have been of some concern?
• How long have these symptoms been experienced?
• Have any traumatic events been witnessed or experienced recently?
• Since the event, have nightmares, disturbing thoughts and memories been disruptive to daily life?
• Since the event, have avoidance behaviours been adopted? (Isolating oneself, or avoiding certain people, places or specific situations)
• Since the event, have there been in obvious difficulties in personal relationships, at work or school?
• Have any other mental health problems been treated in the past? If yes, which therapies proved most beneficial?
• Since the event, have alcohol, medications or recreational drugs been used to try and dispel any symptoms or concerning feelings?
• Since the event, have there been days when self-harm, or harming others been thought about?

Surveys and questionnaires are usually a printed set of questions which a patient is given to answer. This usually serves as a PTSD checklist (PCL).

From there, a mental health professional will use all psychological evaluations and test results (where relevant) to determine symptom criteria for PTSD, as well as the degree of dysfunction in a person’s overall life.