Adjustment disorders. In adjustment disorders, the stressor can be of any severity or type rather than that required by PTSD Criterion A. The diagnosis of an adjustment dis- order is used when the response to a stressor that meets PTSD Criterion A does not meet all other PTSD criteria (or criteria for another mental disorder). An adjustment disorder is also diagnosed when the symptom pattern of PTSD occurs in response to a stressor that does not meet PTSD Criterion A (e.g., spouse leaving, being fired).
Other posttraumatic disorders and conditions. Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily be attributed to PTSD. The diagnosis requires that trauma exposure precede the onset or exacerbation of pertinent symptoms. Moreover, if the symptom response pattern to the extreme stressor meets cri- teria for another mental disorder, these diagnoses should be given instead of, or in addi- tion to, PTSD. Other diagnoses and conditions are excluded if they are better explained by
PTSD (e.g., symptoms of panic disorder that occur only after exposure to traumatic re- minders). If severe, symptom response patterns to the extreme stressor may warrant a sep- arate diagnosis (e.g., dissociative amnesia).
Acute stress disorder. Acute stress disorder is distinguished from PTSD because the symptom pattern in acute stress disorder is restricted to a duration of 3 days to 1 month following exposure to the traumatic event.
Anxiety disorders and obsessive-compulsive disorder. In OCD, there are recurrent intrusive thoughts, but these meet the definition of an obsession. In addition, the intrusive thoughts are not related to an experienced traumatic event, compulsions are usually pres- ent, and other symptoms of PTSD or acute stress disorder are typically absent. Neither the arousal and dissociative symptoms of panic disorder nor the avoidance, irritability, and anxiety of generalized anxiety disorder are associated with a specific traumatic event. The symptoms of separation anxiety disorder are clearly related to separation from home or family, rather than to a traumatic event.
Major depressive disorder. Major depression may or may not be preceded by a trau- matic event and should be diagnosed if other PTSD symptoms are absent. Specifically, ma- jor depressive disorder does not include any PTSD Criterion B or C symptoms. Nor does it include a number of symptoms from PTSD Criterion D or E.
Personality disorders. Interpersonal difficulties that had their onset, or were greatly ex- acerbated, after exposure to a traumatic event may be an indication of PTSD, rather than a personality disorder, in which such difficulties would be expected independently Of any traumatic exposure.
Dissociative disorders. Dissociative amnesia, dissociative identity disorder, and de- personalization-derealization disorder may or may not be preceded by exposure to a trau- matic event or may or may not have co—occurring PTSD symptoms. When full PTSD criteria are also met, however, the I’ISD ”with dissociative symptoms” subtype should be considered.
Conversion disorder (functional neurological symptom disorder). New onset of somatic symptoms within the context of posttraumatic distress might be an indication of PTSD rather than conversion disorder (functional neurological symptom disorder).
Psychotic disorders. Flashbacks in PTSD must be distinguished from illusions, halluci- nations, and other perceptual disturbances that may occur in schizophrenia, brief psy- chotic disorder, and other psychotic disorders; depressive and bipolar disorders with orders due to another medical condition.