PTSD criteria worksheet

What is the theory behind this PTSD criteria worksheet?

Post Traumatic Stress Disorders is classified as a ‘Trauma and Stressor Related Disorder’ in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). People develop PTSD after direct or indirect exposure to an event that is extremely traumatic for them. Soon after the exposure a host of physiological, mental and emotional symptoms appear that become debilitating for the individual’s daily functioning. 

How will the worksheet help?

This worksheet can help as a preliminary checklist for determining if a client meets the criteria for PTSD or not. It is a summarised checklist of the DSM 5 criteria making it quick and easy to use. 

How to use the worksheet?

This worksheet can be used in hospitals, counselling or therapeutic settings where a comprehensive tool is needed to  diagnose PTSD.  The therapist or counsellor can either ask questions pertaining to the symptoms or determine the presence of the mentioned symptoms through the client’s account of their condition. 

PTSD Criteria Worksheet

**This is the DSM-V Diagnostic Criteria for adults, adolescents, and children older than 6 years. 

Name of the Client: ______________________________________________        

Age: ___________      Date: _____________

Name of the Therapist/Counsellor: __________________________________

Criteria A: Presence of a stressor (one required)Criteria B: Intrusion Symptoms: Repeated re-experience of the traumatic event (one required)Criteria C: Avoidance of stimuli related to the traumatic event(one required)Criteria D: Negative Alterations in Cognitions and Mood – that began or worsened after the traumatic event (two required)
Direct experience of the traumatic event
Witnessing the traumatic event
Traumatic event occurred to a close loved one
Indirectly being exposed to aversive details of the traumatic event (in case of professional duties for e.g police officers)
Recurrent distressing memories
Recurrent nightmares
Dissociative reactions for e.g flashbacks
Intense emotional distress in response to trauma triggers
Intense physiological reactions in response to trauma triggers
Avoiding or making an effort to avoid all thoughts and feelings related to the traumatic event
Avoiding or making and effort to avoid all external reminders of the traumatic event (people, places, conversations, activities, objects, situations
Inability to remember a crucial aspect of the trauma event (due to dissociative amnesia)
Persistent and overly negative beliefs about oneself, others and the world in general
Persistent distorted cognitions about the cause of the event leading to excessive self blaming
Persistent negative emotional state
Decreased interest in activities
Feeling isolated
Persistent inability to experience positive emotions

Criteria E: Alterations in arousal and reactivity – that began or worsened after the traumatic eventCriteria F: Duration(required)Criteria G: Functional Significance(required)Criteria H: Exclusion(required)
Irritability or aggression

Risky or destructive behaviour


Heightened startle reaction

Difficulty concentrating

Difficulty sleeping

Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.Observable clinically significant distress or impairment in social, occupational, or other important areas of functioning.Disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Two Specifications

With dissociative symptoms: Along with symptoms of PTSD individual also experiences the following after exposure to trauma triggersDepersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

Additional notes:


American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. 

You can download this worksheet here.

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