1. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; or seeing another person who has recently been, or is being, seriously injured or killed as the result of an accident or physical violence.

2. The traumatic event is persistently reexperienced in at least one of the following ways:

   1. recurrent and intrusive distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)

   2. recurrent distressing dreams of the event

   3. sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative [flashback] episodes, even those that occur upon awakening or when intoxicated)

   4. intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma

3. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

   1. efforts to avoid thoughts or feelings associated with the trauma

   2. efforts to avoid activities or situations that arouse recollections of the trauma

   3. inability to recall an important aspect of the trauma (psychogenic amnesia)

   4. markedly diminished interest in significant activities (in young children, loss of recently acquired developmental skills such as toilet training or language skills)

   5. feeling of detachment or estrangement from others

   6. restricted range of affect, e.g., unable to have loving feelings

   7. sense of a foreshortened future, e.g., does not expect to have a career, marriage, or children, or a long life

4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

   1. difficulty falling or staying asleep

   2. irritability or outbursts of anger

   3. difficulty concentrating

   4. hypervigilance

   5. exaggerated startle response

   6. physiologic reactivity upon exposure to events that symbolize or resemble an aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks out in a sweat when entering any elevator)

5. Duration of the disturbance (symptoms in B, C, and D) of at least one month.

Specify delayed onset if the onset of symptoms was at least six months after the trauma.

SOURCE: American Psychiatric Association, 1987.