PTSD diagnosis: Screening tests and assessments

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Mental health professionals conduct several assessments to diagnose PTSD. These assessments differ from those for physical health conditions, which may involve blood work, imaging tests, biopsies, or physical examinations. Assessments for PTSD involve a mental health professional asking a person questions about their thoughts, feelings, and behaviors.

If a person says they have experienced a traumatic event, a healthcare professional may screen them for PTSD. A PTSD screening is a brief questionnaire to find out whether someone is showing symptoms of PTSD.

While PTSD screening does not determine whether someone has PTSD, it helps healthcare professionals decide whether a person needs further assessment.

People who have a positive screening for PTSD will likely undergo more in-depth assessments. According to the U.S. Department of Veterans Affairs, a PTSD assessment can take 15 minutes to 2 hours, depending on its purpose. If people need information for legal purposes or disability claims, the assessment can take longer.

A PTSD assessment will involve an interview with a mental health professional. A person may also need to complete self-report questionnaires.

Learn more about PTSD.

The following sections describe the types of PTSD tests.

Screening

Healthcare professionals may use the following screening tools for PTSD:

• Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): The PC-PTSD-5 is a five-item screen that identifies people with probable PTSD. It is for use in primary care settings to assess whether someone has had exposure to traumatic events.
• SPAN: SPAN is a four-item self-report screen that assesses four symptoms of PTSD — startle, physical upset, anger, and numbness.
• Short PTSD Rating Interview (SPRINT): The SPRINT is an eight-item screen that assesses core PTSD symptoms, including intrusion, avoidance, numbing, arousal, and general feelings of illness, stress, and social difficulty.
• Trauma Screening Questionnaire (TSQ): The TSQ is a 10-item self-report screen that measures responses to a traumatic event.

Interview-based assessments

If a person has a positive screening, a mental health professional will follow it up with a structured interview for PTSD. Mental health professionals may use the following interview-based assessments to diagnose PTSD:

Clinician-administered PTSD Scale for DSM-5 (CAPS-5)

Clinicians based the CAPS-5 on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which provides diagnostic criteria for mental health conditions in the United States.

The CAPS-5 is the gold standard for assessing PTSD. It is a 30-item interview that takes 45 to 60 minutes to complete.

PTSD Symptom Scale Interview for DSM-5 (PSS-I-5)

The PSS-I-5 is a 24-item interview that uses the DSM-5 criteria to assess PTSD symptoms a person has experienced in the past month. It takes around 20 minutes to complete.

Structured Clinical Interview for DSM-5 (SCID-5)

The SCID-5 is a semi-structured diagnostic interview that mental health professionals use to reach diagnoses according to the DSM-5. It has separate modules for different diagnostic categories. A PTSD diagnosis stems from following the PTSD diagnostic algorithm.

A SCID-5 can take anywhere from 15 minutes to several hours.

Structured Interview for PTSD (SI-PTSD)

The SI-PTSD is a clinical interview that assesses 17 symptoms of PTSD and survival and behavioral guilt. A SI-PTSD takes 20 to 30 minutes to complete.

Self-report questionnaires

In addition to a structured interview, a mental health professional may ask a person to complete one of the following self-report questionnaires to help them reach a diagnosis:

• Davidson Trauma Scale (DTS): The DTS is a self-report tool that assesses 17 symptoms of PTSD.
• Dissociative Subtype of PTSD Scale (DSPS): The DSPS is a 15-item self-report measure or semi-structured interview that checks for the dissociative subtype of PTSD.
• Dissociative Symptoms Scale (DSS) and Brief Dissociative Symptoms Scale (DSS-B): The DSS is a 20-item self-report tool that assesses for symptoms of dissociation within the past week. The DSS-B is an 8-item version of the DSS that measures the four domains of dissociation.
• Impact of Event Scale-Revised (IES-R): The IES-R is a 22-item self-report tool that corresponds with the symptoms of PTSD included in the DSM-4.
• Mississippi Scale for Combat-Related PTSD (M-PTSD): The M-PTSD is a 35-item self-report tool that evaluates PTSD due to combat in military veterans. It corresponds with the DSM-3 symptoms of PTSD.
• Modified PTSD Symptom Scale (MPSS-SR): The MPSS-SR is a self-report measure that assesses PTSD according to the symptoms included in the DSM-3.
• Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5): The PDS-5 is a 24-item self-report tool evaluating the severity of PTSD symptoms within the last month according to DSM-5 criteria.
• PTSD Checklist for DSM-5 (PCL-5): The PCL-5 is a 20-item self-report tool that assesses PTSD symptoms according to the DSM-5. Mental health professionals can use it to screen for PTSD or to make a provisional diagnosis, as well as to monitor symptom changes throughout treatment.
• Trauma Symptom Checklist — 40 (TSC-40): The TSC-40 is a 40-question self-report tool that measures symptomatic distress in adults resulting from traumatic experiences in childhood or adulthood.
• Trauma Symptom Inventory-2 (TSI-2): The TSI-2 self-report questionnaire contains 136 items that assess PTSD symptoms and other psychological outcomes.

Mental health professionals use the following diagnostic criteria from the DSM-5 to diagnose PTSD in adults:

Criterion A

A person had exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

• having direct exposure to the traumatic event
• witnessing the traumatic event
• learning that a traumatic event happened to a family member or close friend
• having indirect exposure to trauma through professional duties, such as those of medics and first responders

Criterion B

A person persistently re-experiences the traumatic event in one or more of the following ways:

• unwanted distressing memories of the traumatic event
• nightmares
• flashbacks
• emotional distress after exposure to reminders of the traumatic event
• physical reactions after exposure to reminders of the traumatic event

Criterion C

A person avoids stimuli associated with the trauma in one or both of the following ways:

• avoidance of distressing memories, thoughts, or feelings related to the trauma
• avoidance of external reminders, such as people, places, or activities that trigger distressing memories, thoughts, or feelings about the trauma

Criterion D

A person has negative thoughts or feelings that developed or worsened after the traumatic event in two or more of the following ways:

• an inability to recall important parts of the traumatic event
• overly negative beliefs or expectations about themselves or the world
• persistent feelings of blame toward themselves or others for causing the trauma
• a persistent negative emotional state, such as fear, anger, guilt, or shame
• little interest in participating in activities
• a feeling of detachment or isolation
• difficulty experiencing positive emotions such as happiness, satisfaction, or loving feelings

Criterion E

A person experienced trauma-related arousal and reactivity that developed or worsened after the trauma in two or more of the following ways:

• aggression and irritability
• reckless or self-destructive behavior
• hypervigilance
• heightened startle response
• difficulty concentrating
• difficulty sleeping

Criterion F

Symptoms have continued for more than 1 month.

Criterion G

Symptoms cause significant distress or difficulty in functioning, such as socially or occupationally.

Criterion H

Symptoms are not due to medication, substance use, or another medical condition.

Specifications

If a person’s symptoms meet the criteria for PTSD, a mental health professional will also evaluate whether a person has the following two specifications:

Dissociative specification

In response to trauma-related stimuli, a person may experience persistent or recurrent symptoms of:

• Depersonalization: feeling detached from themselves or feeling like they are an outside observer
• Derealization: experiencing their surroundings as if they are unreal, dreamlike, or distorted

Delayed specification

A person may experience some symptoms immediately, but some people may not meet the full diagnostic criteria for PTSD until at least 6 months after the traumatic event.

Mental health professionals diagnose PTSD using screening tools, structured interviews, and self-report questionnaires. They can use tests and assessments that take anywhere from 15 minutes to 2 hours to complete.

Many of the assessments evaluate PTSD according to the criteria in the DSM-5. The DSM-5 includes eight criteria (labeled “A” through “H”) and two specifiers to determine whether someone has PTSD.

People with PTSD experience many emotional and physical symptoms that affect their daily activities. They typically re-experience the traumatic event through flashbacks, nightmares, or physical sensations that create distress or difficulty functioning.

Treatment for PTSD involves a combination of psychotherapy and medications. Mental health professionals work with each person to determine the best course of treatment.