For a PTSD diagnosis, a person must have 2 or more of the following Criterion D symptoms:

• Inability to recall important aspects of the traumas (not due to a head injury, alcohol, or drugs)
• Persistent and exaggerated negative beliefs about oneself, others, or the world
• Persistent and distorted blame of self or others for causing the traumas or for consequences that resulted
• Persistent negative emotions (e.g., fear, guilt, anger)
• Markedly diminished interest or participation in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions (e.g., unable to feel happiness)

Symptoms included in Criterion D reflect persistent changes in beliefs or mood that have developed or worsened after the traumatic event.

People with PTSD often have erroneous beliefs about the causes or consequences of the traumatic events that lead them to blame themselves or others, or believe that they are inadequate, weak, or permanently changed for the worse since exposure to the traumatic events.

People with PTSD are also likely to persistently experience negative emotions such as anger, guilt, or shame while being unable to experience positive feelings such as love or happiness. Such constricted affect makes it extremely difficult to sustain meaningful interpersonal relationships, which may contribute to a sense of detachment or estrangement from others.