Symptoms included in Criterion E reflect the heightened physiological activation experienced by people with PTSD. To be counted towards a PTSD diagnosis, these symptoms must have developed (or worsened) after the traumatic events.

For a PTSD diagnosis, a person must have 2 or more of the following Criterion E symptoms. Select each to view Criterion E symptoms.

  • A man yelling at his spouse, she is looking away sad.

    Irritable behavior or outbursts of anger

    To meet criteria for this symptom, the individual must have expressed his/her anger or irritation behaviorally (i.e., verbally, physically, or both).
  • A car taking a corner very fast

    Reckless or self-destructive behavior

    Examples of reckless and self-destructive behavior include (but are not limited to): unsafe sex, reckless driving, and suicidal behavior.
  • Man looking out window

    Hypervigilance

    The hypervigilance in PTSD may take many forms, usually based on a selective attentional bias to threat, with an inability to control that attentional bias. This can translate into behaviors such as compulsive checking, a need to position oneself so one can constantly scan the environment, an inability to relax or feel safe, and a feeling of paranoia when it is more severe.
  • Woman looking very frightened

    Exaggerated startle response

    When a person with PTSD is startled, they are more likely than someone without PTSD to experience a racing heart, sweating, rapid breathing, and tense muscles, and these reactions are likely to take longer to subside. For instance, when a car backfires, a person with combat-related PTSD may have a startle response that causes him to "hit the deck" because it reminds him of enemy fire.
  • Woman working, distracted looking out window

    Problems with concentration

    Individuals with PTSD often report difficulty concentrating because of the heightened state of arousal and hypervigilance, preoccupation with internal emotional states, stress reactivity and inability to screen out distractions, or the fatigue that comes with difficulty sleeping.
  • Woman having trouble falling asleep in bed

    Difficulty falling or staying asleep, or restless sleep

    People with PTSD may have sleep problems for many reasons, such as having difficulty changing their state from being "on alert" to protect themselves from danger. They may worry or have negative thoughts or have nightmares which interfere with both falling and staying asleep. They may use drugs or alcohol to help them cope with their symptoms.