medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms:  The individual’s symptoms meet the criteria for post-
traumatic stress disorder, and in addition, in response to the stressor, the individual ex-
periences persistent or recurrent symptoms of either of the following:
1.Depersonalization:  Persistent or recurrent experiences of feeling detached from,
and as if one were an outside observer of, one’s mental processes or body (e.g.,
feeling as though one were in a dream; feeling a sense of unreality of self or body
or of time moving slowly).
2.Derealization:  Persistent or recurrent experiences of unreality of surroundings
(e.g., the world around the individual is experienced as unreal, dreamlike, distant,
or distorted).
Note:  To use this subtype, the dissociative symptoms must not be attributable to the
physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxica-
tion) or another medical condition (e.g., complex partial seizures).
Specify if:
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).
Posttraumatic Stress Disorder for Children 6 Years and Younger
A. In children 6 years and younger, exposure to actual or threatened death, serious injury,
or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others, especially primary care-
givers.